Provider Demographics
NPI:1629777347
Name:MONTGOMERY, JESSICA RAE (LMHC, LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 MARKET ST.
Mailing Address - Street 2:2ND FL.
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3317
Mailing Address - Country:US
Mailing Address - Phone:317-494-2460
Mailing Address - Fax:
Practice Address - Street 1:3535 MARKET ST.
Practice Address - Street 2:2ND FL.
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3317
Practice Address - Country:US
Practice Address - Phone:317-494-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99116587A101YM0800X
PAPC016471101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health