Provider Demographics
NPI:1972000826
Name:MONTGOMERY, TAMIKA NICOLE (LMFT)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:NICOLE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3257 CHADWOOD LANE NORTH DR APT 1A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3559
Mailing Address - Country:US
Mailing Address - Phone:317-652-4660
Mailing Address - Fax:
Practice Address - Street 1:8888 KEYSTONE XING STE 1300
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-4600
Practice Address - Country:US
Practice Address - Phone:317-575-4103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-08
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001973A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist