Provider Demographics
NPI:1952799355
Name:MONTGOMERY, STEPHANIE D (LPCC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 2ND ST STE 406
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-3174
Mailing Address - Country:US
Mailing Address - Phone:270-826-8761
Mailing Address - Fax:270-826-8737
Practice Address - Street 1:203 N ELM ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3132
Practice Address - Country:US
Practice Address - Phone:270-826-8761
Practice Address - Fax:270-826-8737
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY165585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100401300Medicaid