MEDICARE: CHERYEL MONTGOMERY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103TA0700X	Adult Development & Aging Psychologist
3	103TH0100X	Health Service Psychologist
4	174200000X	Meals Provider
5	343900000X	Non-emergency Medical Transport (VAN)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6600	OTHER	LA	DRIVER
2	0066	OTHER	LA	DRIVER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740868561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYEL MONTGOMERY

Provider Business Mailing Address
First Line	:	1303 BALSAM AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70807-2901
Country	:	US
Telephone Number	:	225-715-9744
Fax Number	:

Provider Business Practice Location Address
First Line	:	1303 BALSAM AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70807-2901
Country	:	US
Telephone Number	:	225-715-9744
Fax Number	:

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

Provider Enumeration Date	:	04/01/2021
Last Update Date	:	06/22/2023

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Directions to “ CHERYEL MONTGOMERY ” Practice Location

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