Healthcare Provider Details

I. General information

NPI: 1346897634
Provider Name (Legal Business Name): ERIN JEANETTE MONTGOMERY, LMFT, LSAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E MESCALERO RD
ROSWELL NM
88201-6542
US

IV. Provider business mailing address

110 E MESCALERO RD
ROSWELL NM
88201-6542
US

V. Phone/Fax

Practice location:
  • Phone: 575-755-2272
  • Fax: 575-622-3325
Mailing address:
  • Phone: 575-755-2272
  • Fax: 575-622-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCAMF0213311
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCTB-2022-0112
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: