Healthcare Provider Details

I. General information

NPI: 1053966697
Provider Name (Legal Business Name): STACEY MONTGOMERY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 W MARKET ST
AKRON OH
44313-7000
US

IV. Provider business mailing address

1815 W MARKET ST
AKRON OH
44313-7000
US

V. Phone/Fax

Practice location:
  • Phone: 330-993-4649
  • Fax:
Mailing address:
  • Phone: 330-993-4649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2303856
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: