Healthcare Provider Details

I. General information

NPI: 1487686143
Provider Name (Legal Business Name): KARMELLA RHEA MONTGOMERY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 MAYO DR
BARLING AR
72923-1660
US

IV. Provider business mailing address

4253 N CROSSOVER RD
FAYETTEVILLE AR
72703-4593
US

V. Phone/Fax

Practice location:
  • Phone: 479-494-5760
  • Fax: 479-484-8142
Mailing address:
  • Phone: 479-521-5731
  • Fax: 479-521-6520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP0707037
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: