Provider Demographics
NPI:1760790182
Name:MONTGOMERY, VALERIE B (MA, LPC)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:B
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 N WAHSATCH AVE # 312
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6941
Mailing Address - Country:US
Mailing Address - Phone:719-598-7800
Mailing Address - Fax:719-362-4351
Practice Address - Street 1:716 N TEJON ST # 7
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1012
Practice Address - Country:US
Practice Address - Phone:719-598-7800
Practice Address - Fax:719-204-3829
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2024-04-02
Deactivation Date:2015-04-23
Deactivation Code:
Reactivation Date:2015-09-04
Provider Licenses
StateLicense IDTaxonomies
CO5761101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional