Provider Demographics
NPI:1922109065
Name:MONTGOMERY, CATHY (PHD)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 FREMONT AVE S
Mailing Address - Street 2:
Mailing Address - City:MPLS
Mailing Address - State:MN
Mailing Address - Zip Code:35408
Mailing Address - Country:US
Mailing Address - Phone:612-872-0099
Mailing Address - Fax:
Practice Address - Street 1:2804 FREMONT AVE S
Practice Address - Street 2:
Practice Address - City:MPLS
Practice Address - State:MN
Practice Address - Zip Code:35408
Practice Address - Country:US
Practice Address - Phone:612-872-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2710103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist