Provider Demographics
NPI:1669116596
Name:MONTGOMERY, ALIX MICHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:ALIX
Middle Name:MICHELLE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALIX
Other - Middle Name:MICHELLE
Other - Last Name:CHANNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:182 THORNLEIGH CT
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-1864
Mailing Address - Country:US
Mailing Address - Phone:317-361-5127
Mailing Address - Fax:
Practice Address - Street 1:7230 ARBUCKLE CMNS STE 252
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1798
Practice Address - Country:US
Practice Address - Phone:317-456-2487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34009389A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical