Provider Demographics
NPI:1659592277
Name:MONTGOMERY, AYNGI (MED MDIV LPC NCC)
Entity Type:Individual
Prefix:
First Name:AYNGI
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MED MDIV LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 700082
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-0082
Mailing Address - Country:US
Mailing Address - Phone:918-852-9644
Mailing Address - Fax:
Practice Address - Street 1:1305 N HIGHWAY 66
Practice Address - Street 2:SUITE B
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-2460
Practice Address - Country:US
Practice Address - Phone:918-852-9644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200266240BMedicaid