Healthcare Provider Details

I. General information

NPI: 1801717996
Provider Name (Legal Business Name): MAYCEE MONTGOMERY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 BAYOU BLVD STE 20
PENSACOLA FL
32503-1908
US

IV. Provider business mailing address

5812 LINDA ST
PENSACOLA FL
32506-4671
US

V. Phone/Fax

Practice location:
  • Phone: 850-583-1342
  • Fax: 850-665-0132
Mailing address:
  • Phone: 918-309-8997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number35012
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: