=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750528113
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUE ANN MONTGOMERY PHD, LCMFT, LCAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2009
-----------------------------------------------------
Last Update Date | 02/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 E 9TH AVE
-----------------------------------------------------
City | HUTCHINSON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67501-6210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-669-8404
-----------------------------------------------------
Fax | 620-665-7619
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210 E 30TH AVE STE 120
-----------------------------------------------------
City | HUTCHINSON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67502-2463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-669-8404
-----------------------------------------------------
Fax | 316-683-6255
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 073
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------