Provider Demographics
NPI:1821272337
Name:MONTGOMERY, AMANDA C (DMIN, LMFT)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:C
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:DMIN, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CUSTER WAY SW STE 101
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3330
Mailing Address - Country:US
Mailing Address - Phone:360-870-9080
Mailing Address - Fax:
Practice Address - Street 1:204 CUSTER WAY SW STE 101
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-3330
Practice Address - Country:US
Practice Address - Phone:360-870-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60172449106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist