MEDICARE: MELINDA M. MONTGOMERY M.S., L.P.C., L.P.A.

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	18065	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6232LC	OTHER	TX	BLUECROSS BLUESHIELD OF T
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619192986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA M. MONTGOMERY M.S., L.P.C., L.P.A.

Provider Business Mailing Address
First Line	:	2501 DENA DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-5014
Country	:	US
Telephone Number	:	325-223-0786
Fax Number	:	325-617-4196

Provider Business Practice Location Address
First Line	:	2501 DENA DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-5014
Country	:	US
Telephone Number	:	325-223-0786
Fax Number	:	325-617-4196

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	05/10/2013

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