Provider Demographics
NPI:1508246125
Name:MONTGOMERY, THOMPSON ORION (MA)
Entity Type:Individual
Prefix:
First Name:THOMPSON
Middle Name:ORION
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:LYNNETTE
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 S FREYA ST
Mailing Address - Street 2:RED BLDG STE 103B
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-4864
Mailing Address - Country:US
Mailing Address - Phone:509-530-1399
Mailing Address - Fax:
Practice Address - Street 1:104 S FREYA ST
Practice Address - Street 2:RED BLDG STE 103B
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202
Practice Address - Country:US
Practice Address - Phone:509-530-1399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health