Provider Demographics
NPI:1770135816
Name:MONTGOMERY, JOY (LLPC)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43643 CEDARHURST DR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-4573
Mailing Address - Country:US
Mailing Address - Phone:734-787-6393
Mailing Address - Fax:
Practice Address - Street 1:43643 CEDARHURST DR
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-4573
Practice Address - Country:US
Practice Address - Phone:734-787-6393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017780101Y00000X
101YM0800X
MI6401222769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor