Provider Demographics
NPI:1932477346
Name:MONTGOMERY, ROBERT A
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 PARALLEL DR
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-5720
Mailing Address - Country:US
Mailing Address - Phone:707-263-4338
Mailing Address - Fax:707-263-1507
Practice Address - Street 1:991 PARALLEL DR
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-5720
Practice Address - Country:US
Practice Address - Phone:707-263-4338
Practice Address - Fax:707-263-1507
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health