Provider Demographics
NPI:1851655880
Name:MONTGOMERY, KAREN (LMHP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16335 CHICAGO CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2071
Mailing Address - Country:US
Mailing Address - Phone:402-932-0901
Mailing Address - Fax:402-932-0906
Practice Address - Street 1:11330 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3679
Practice Address - Country:US
Practice Address - Phone:402-932-0901
Practice Address - Fax:402-932-0906
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1227101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100253517-00Medicaid