Provider Demographics
NPI:1740367002
Name:MONTGOMERY, HENRY A (PHD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:A
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 W RIVERSIDE AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1016
Mailing Address - Country:US
Mailing Address - Phone:509-744-0778
Mailing Address - Fax:509-344-0779
Practice Address - Street 1:905 W RIVERSIDE AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1016
Practice Address - Country:US
Practice Address - Phone:509-744-0778
Practice Address - Fax:509-344-0779
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 1963103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0130273OtherLABOR AND INDUSTRIES
WAG319000280Medicare UPIN
WA1740367002Medicare PIN