Provider Demographics
NPI:1952623373
Name:MONTGOMERY, LISA M (LPCC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:ELMORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCA
Mailing Address - Street 1:125 S MAIN CROSS ST
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-1065
Mailing Address - Country:US
Mailing Address - Phone:606-638-0938
Mailing Address - Fax:
Practice Address - Street 1:125 S MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-1065
Practice Address - Country:US
Practice Address - Phone:606-638-0938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY104645101YM0800X
KYKY1393101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100293420Medicaid