MEDICARE: RUSSELL HAROLD MONTGOMERY MA LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	73514	TX
2	101YP2500X	Professional Counselor	PCCI3743	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053851527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL HAROLD MONTGOMERY MA LPC

Provider Business Mailing Address
First Line	:	1100 NASA PKWY STE 201A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2813
Country	:	US
Telephone Number	:	832-581-5847
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 NASA PKWY STE 201A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2813
Country	:	US
Telephone Number	:	832-581-5847
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2017
Last Update Date	:	11/23/2021

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