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General NPI Number Information
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NPI Number | 1902451560
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Entity Type | Individual
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Provider Name | STEPHEN MONTGOMERY
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Gender | Male
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Dates
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Enumeration Date | 08/09/2019
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 16244 S MILITARY TRL STE 110
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City | DELRAY BEACH
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State | FL
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Zip | 33484-6505
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Country | US
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Telephone | 561-865-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 S PARROTT AVE APT 127
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City | OKEECHOBEE
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State | FL
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Zip | 34974-5276
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Country | US
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Telephone | 904-254-5578
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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