Healthcare Provider Details

I. General information

NPI: 1134732282
Provider Name (Legal Business Name): ANCHORED HOPE AND HEALING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 JUDSON RD STE 1000
LONGVIEW TX
75601-5119
US

IV. Provider business mailing address

PO BOX 1285
LONGVIEW TX
75606-1285
US

V. Phone/Fax

Practice location:
  • Phone: 903-251-9717
  • Fax:
Mailing address:
  • Phone: 903-251-9717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY MONTGOMERY
Title or Position: LCSW
Credential: LCSW
Phone: 430-558-0941