Provider Demographics
NPI:1649911579
Name:MONTGOMERY, CINDY LA-TISCHE (LPC)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:LA-TISCHE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:LA-TISCHE
Other - Last Name:GAMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:1272 N LAYMAN ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-1745
Mailing Address - Country:US
Mailing Address - Phone:626-720-9874
Mailing Address - Fax:
Practice Address - Street 1:4111 E VALLEY AUTO DR STE 106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4607
Practice Address - Country:US
Practice Address - Phone:323-910-0187
Practice Address - Fax:480-401-2350
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-19858101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional