Provider Demographics
NPI:1881365708
Name:MONTGOMERY COUNSELING SERVICE PLLC
Entity type:Organization
Organization Name:MONTGOMERY COUNSELING SERVICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:BA/LAC
Authorized Official - Phone:701-572-3800
Mailing Address - Street 1:1510 2ND AVE W STE 102
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-4174
Mailing Address - Country:US
Mailing Address - Phone:701-572-3800
Mailing Address - Fax:
Practice Address - Street 1:1510 2ND AVE W STE 102
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4174
Practice Address - Country:US
Practice Address - Phone:701-572-3800
Practice Address - Fax:701-572-3805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty