Provider Demographics
NPI:1134806581
Name:CROWNED THERAPY AND WELLNESS
Entity type:Organization
Organization Name:CROWNED THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TANIKA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFTA
Authorized Official - Phone:251-622-5964
Mailing Address - Street 1:4730 SHARPLESS DR E
Mailing Address - Street 2:
Mailing Address - City:EIGHT MILE
Mailing Address - State:AL
Mailing Address - Zip Code:36613-9237
Mailing Address - Country:US
Mailing Address - Phone:251-622-5964
Mailing Address - Fax:
Practice Address - Street 1:951 SCHILLINGER ROAD N
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575
Practice Address - Country:US
Practice Address - Phone:251-622-5964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TANIKA MONTGOMERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty