Provider Demographics
NPI:1972885382
Name:MONTGOMERY, KATHRYN (LCPC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHRYN
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:1414 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5023
Mailing Address - Country:US
Mailing Address - Phone:208-850-9878
Mailing Address - Fax:208-395-1948
Practice Address - Street 1:1414 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5023
Practice Address - Country:US
Practice Address - Phone:208-850-9878
Practice Address - Fax:208-395-1948
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC 5810101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health