MEDICARE: MS. JEANNE MONTGOMERY LMFT

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	101YM0800X	Mental Health Counselor	MFT 120	GA

General Provider Information

NPI Number	:	1104997667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEANNE MONTGOMERY LMFT

Provider Business Mailing Address
First Line	:	2200 CENTURY PKWY NE
Second Line	:	SUITE 200
City	:	ATLANTA
State	:	GA
Zip	:	30345-3154
Country	:	US
Telephone Number	:	404-633-3347
Fax Number	:	404-325-3663

Provider Business Practice Location Address
First Line	:	2200 CENTURY PKWY NE
Second Line	:	SUITE 200
City	:	ATLANTA
State	:	GA
Zip	:	30345-3154
Country	:	US
Telephone Number	:	404-633-3347
Fax Number	:	404-325-3663

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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