Provider Demographics
NPI:1851517494
Name:MONTGOMERY, GRACE ANN (MFT)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:ANN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8934 BACHRY PL
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-2605
Mailing Address - Country:US
Mailing Address - Phone:818-353-5867
Mailing Address - Fax:
Practice Address - Street 1:8934 BACHRY PL
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-2605
Practice Address - Country:US
Practice Address - Phone:818-353-5867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT31715106H00000X
CA31715106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist