Provider Demographics
NPI:1821675026
Name:MONTGOMERY, PHILIP DARIAN (LPC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:DARIAN
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 E 68TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-6278
Mailing Address - Country:US
Mailing Address - Phone:773-680-0615
Mailing Address - Fax:
Practice Address - Street 1:2317 E 68TH ST APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-6278
Practice Address - Country:US
Practice Address - Phone:773-680-0615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178013045101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional