Provider Demographics
NPI:1013337542
Name:MONTGOMERY, REBEKAH DOVE (PHD, LPC-S)
Entity Type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:DOVE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PHD, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 972844
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-0323
Mailing Address - Country:US
Mailing Address - Phone:734-255-4000
Mailing Address - Fax:
Practice Address - Street 1:7800 W OUTER DR STE LL04
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3461
Practice Address - Country:US
Practice Address - Phone:734-255-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013825101YM0800X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251B00000XAgenciesCase Management