Healthcare Provider Details

I. General information

NPI: 1053018523
Provider Name (Legal Business Name): TANIKA MICHELLE MONTGOMERY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8984 MOFFETT RD STE A
SEMMES AL
36575-5310
US

IV. Provider business mailing address

4730 SHARPLESS DR E
EIGHT MILE AL
36613-9237
US

V. Phone/Fax

Practice location:
  • Phone: 251-622-5964
  • Fax: 251-910-9722
Mailing address:
  • Phone: 251-622-5964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI-1114
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: