Healthcare Provider Details

I. General information

NPI: 1457793630
Provider Name (Legal Business Name): JOYRE AMBRELLE MONTGOMERY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOYRE AMBRELLE SIMS

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6727 HERITAGE BUSINESS CT STE 720
CHATTANOOGA TN
37421-2597
US

IV. Provider business mailing address

809 N VALLEYWOOD CIR
HIXSON TN
37343-2448
US

V. Phone/Fax

Practice location:
  • Phone: 423-314-7768
  • Fax:
Mailing address:
  • Phone: 423-903-8018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7270
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: