Provider Demographics
NPI:1902228950
Name:MONTGOMERY, BETTY
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
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 1:501 DARBY CREEK RD STE 16
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1606
Mailing Address - Country:US
Mailing Address - Phone:859-227-2337
Mailing Address - Fax:859-268-2472
Practice Address - Street 1:501 DARBY CREEK RD STE 16
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1606
Practice Address - Country:US
Practice Address - Phone:859-227-2337
Practice Address - Fax:859-268-2472
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical