Healthcare Provider Details

I. General information

NPI: 1609614981
Provider Name (Legal Business Name): ASHLYNN MONTGOMERY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 DALLAS STREET
TALIHINA OK
74571-9998
US

IV. Provider business mailing address

2701 W UNIVERSITY BLVD
DURANT OK
74701-2997
US

V. Phone/Fax

Practice location:
  • Phone: 918-942-1033
  • Fax: 918-574-6150
Mailing address:
  • Phone: 580-740-4053
  • Fax: 877-725-8976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: