Provider Demographics
NPI:1750528113
Name:MONTGOMERY, SUE ANN (PHD, LCMFT, LCAC)
Entity type:Individual
Prefix:DR
First Name:SUE
Middle Name:ANN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PHD, LCMFT, LCAC
Other - Prefix:DR
Other - First Name:SUE
Other - Middle Name:ANN
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LCMFT, LCAC
Mailing Address - Street 1:210 E 30TH AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-2463
Mailing Address - Country:US
Mailing Address - Phone:620-669-8404
Mailing Address - Fax:316-683-6255
Practice Address - Street 1:1 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-6210
Practice Address - Country:US
Practice Address - Phone:620-669-8404
Practice Address - Fax:620-665-7619
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS073106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist