Provider Demographics
NPI:1871022319
Name:MONTGOMERY, AUDREY RENEE
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:RENEE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 COLLIER DR STE 600
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-5279
Mailing Address - Country:US
Mailing Address - Phone:405-928-5996
Mailing Address - Fax:405-701-3329
Practice Address - Street 1:121 COLLIER DR STE 600
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-5279
Practice Address - Country:US
Practice Address - Phone:405-928-5996
Practice Address - Fax:405-701-3329
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health