Provider Demographics
NPI:1750617106
Name:MONTGOMERY, JUDY (LMHC)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 DAWSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-5322
Mailing Address - Country:US
Mailing Address - Phone:502-239-1494
Mailing Address - Fax:502-239-1494
Practice Address - Street 1:8500 DAWSON HILL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-5322
Practice Address - Country:US
Practice Address - Phone:502-239-1494
Practice Address - Fax:502-239-1494
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001047A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health