Provider Demographics
NPI:1801223722
Name:MONTGOMERY, KIMBERLEY (MA,LPC-S)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MA,LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 DUBLIN TRL
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-6753
Mailing Address - Country:US
Mailing Address - Phone:469-426-7735
Mailing Address - Fax:
Practice Address - Street 1:106 S BRYAN BELT LINE RD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-4350
Practice Address - Country:US
Practice Address - Phone:972-882-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-09
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68604101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional