MEDICARE: MRS. CASSANDRA MONTGOMERY LPC, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	84742	TX
2	106H00000X	Marriage & Family Therapist	3182	LA
3	172V00000X	Community Health Worker	19390	TX
4	251B00000X	Case Management Agency
5	251S00000X	Community/Behavioral Health Agency	84742	TX
6	101YP2500X	Professional Counselor	3182	LA

General Provider Information

NPI Number	:	1043588718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CASSANDRA MONTGOMERY LPC, LMFT

Provider Business Mailing Address
First Line	:	1717 MARSHALL ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101
Country	:	US
Telephone Number	:	318-226-9944
Fax Number	:	318-226-9942

Provider Business Practice Location Address
First Line	:	1111 W MOCKINGBIRD LN STE 1030
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-5028
Country	:	US
Telephone Number	:	972-489-5552
Fax Number	:	318-577-1559

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	07/16/2025

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