Provider Demographics
NPI:1629123880
Name:DR. HENRY A. MONTGOMERY
Entity Type:Organization
Organization Name:DR. HENRY A. MONTGOMERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-443-6149
Mailing Address - Street 1:905 W RIVERSIDE AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1016
Mailing Address - Country:US
Mailing Address - Phone:509-744-0778
Mailing Address - Fax:
Practice Address - Street 1:905 W RIVERSIDE AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1016
Practice Address - Country:US
Practice Address - Phone:509-744-0778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0130273OtherLABOR AND INDUSTRIES