Provider Demographics
NPI:1518452317
Name:MONTGOMERY, SHANTERIA SHONTRECE (BS)
Entity Type:Individual
Prefix:
First Name:SHANTERIA
Middle Name:SHONTRECE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 YOUREE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 S HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449
Practice Address - Country:US
Practice Address - Phone:318-256-5200
Practice Address - Fax:318-256-5201
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor