Provider Demographics
NPI:1134580202
Name:MONTGOMERY, CHERI (MSC)
Entity type:Individual
Prefix:MS
First Name:CHERI
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 E BONANZA RD STE 17
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-6105
Mailing Address - Country:US
Mailing Address - Phone:702-280-7829
Mailing Address - Fax:
Practice Address - Street 1:4250 E BONANZA RD STE 17
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-6105
Practice Address - Country:US
Practice Address - Phone:702-280-7829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0655106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist