Provider Demographics
NPI:1104592252
Name:MONTGOMERY, LORI RUNYAN (LPC-A)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:RUNYAN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 ROBIN DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76262-9301
Mailing Address - Country:US
Mailing Address - Phone:817-706-4299
Mailing Address - Fax:
Practice Address - Street 1:1452 HUGHES RD STE 200
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-9221
Practice Address - Country:US
Practice Address - Phone:682-233-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86683101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional