Provider Demographics
NPI:1265733398
Name:MONTGOMERY, EMILY LYTLE (MHR, LPC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:LYTLE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MHR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15617 HATTERLY LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-4182
Mailing Address - Country:US
Mailing Address - Phone:405-229-7501
Mailing Address - Fax:
Practice Address - Street 1:13909 TECHNOLOGY DR STE A1
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1060
Practice Address - Country:US
Practice Address - Phone:405-708-6331
Practice Address - Fax:405-708-6331
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
OK6274101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst