Provider Demographics
NPI:1790089027
Name:MONTGOMERY, MINDY BETH (BHRS)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:BETH
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:BETH
Other - Last Name:NEILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4436 NW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2212
Mailing Address - Country:US
Mailing Address - Phone:405-858-2700
Mailing Address - Fax:405-272-1596
Practice Address - Street 1:1140 N HUDSON AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-3918
Practice Address - Country:US
Practice Address - Phone:405-858-1700
Practice Address - Fax:405-272-1596
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor