MEDICARE: KATIE MARTIN 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	106H00000X	Marriage & Family Therapist	242791	KY
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1629665187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE MARTIN MONTGOMERY LMFT

Provider Business Mailing Address
First Line	:	1509 COLD SPRINGS RD
Second Line	:
City	:	ANCHORAGE
State	:	KY
Zip	:	40223-1407
Country	:	US
Telephone Number	:	415-920-3084
Fax Number	:

Provider Business Practice Location Address
First Line	:	1509 COLD SPRINGS RD
Second Line	:
City	:	ANCHORAGE
State	:	KY
Zip	:	40223-1407
Country	:	US
Telephone Number	:	415-920-3084
Fax Number	:

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

Provider Enumeration Date	:	12/30/2020
Last Update Date	:	12/30/2020

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