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NPI Code Detail

MEDICARE: HARVEY LEE MONTGOMERY

MEDICARE: HARVEY LEE MONTGOMERY
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
1101YM0800XMental Health CounselorLH00004639WA

General Provider Information

NPI Number : 1760579619
Entity Type Code : Individual
Provider Name (Legal Business Name) : HARVEY LEE MONTGOMERY
Provider Business Mailing Address
First Line : PO BOX 565
Second Line :
City : PORT TOWNSEND
State : WA
Zip : 98368-0565
Country : US
Telephone Number : 360-385-0321
Fax Number : 360-385-3944
Provider Business Practice Location Address
First Line : 884 W PARK AVE
Second Line :
City : PORT TOWNSEND
State : WA
Zip : 98368-2273
Country : US
Telephone Number : 360-385-0321
Fax Number : 360-385-3944
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 07/08/2007

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Directions to “ HARVEY LEE MONTGOMERY ” Practice Location

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