Provider Demographics
NPI:1629321369
Name:MONTGOMERY, CARRON ELLSPERMANN (LPC, RPT)
Entity Type:Individual
Prefix:
First Name:CARRON
Middle Name:ELLSPERMANN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9915 ENSLEY LN
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-2460
Mailing Address - Country:US
Mailing Address - Phone:913-515-6927
Mailing Address - Fax:
Practice Address - Street 1:4500 COLLEGE BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1760
Practice Address - Country:US
Practice Address - Phone:913-338-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2436101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor