Provider Demographics
NPI:1477960623
Name:MONTGOMERY, JANETH KAY
Entity Type:Individual
Prefix:
First Name:JANETH
Middle Name:KAY
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 MARK TRL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73141-4414
Mailing Address - Country:US
Mailing Address - Phone:405-604-1048
Mailing Address - Fax:405-427-3213
Practice Address - Street 1:3017 N MARTIN LUTHER KING AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-3321
Practice Address - Country:US
Practice Address - Phone:405-427-3200
Practice Address - Fax:405-427-3213
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker