Provider Demographics
NPI:1942813431
Name:MONTGOMERY, CHELSEA LEA
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:LEA
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 1:23905 LOS CODONA AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5894
Mailing Address - Country:US
Mailing Address - Phone:424-571-0779
Mailing Address - Fax:
Practice Address - Street 1:1200 AVIATION BLVD STE 100
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4059
Practice Address - Country:US
Practice Address - Phone:310-376-2468
Practice Address - Fax:310-376-6068
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician