Healthcare Provider Details

I. General information

NPI: 1720132236
Provider Name (Legal Business Name): AARON R MONTGOMERY MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 THE CITY DR S
ORANGE CA
92868-3303
US

IV. Provider business mailing address

401 THE CITY DR S
ORANGE CA
92868-3303
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-5015
  • Fax:
Mailing address:
  • Phone: 714-834-5015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY28475
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC49608
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: