MEDICARE: LAURA ELIZABETH MONTGOMERY M.ED., BCBA

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	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-19-36649	OTHER	TX	BACB

General Provider Information

NPI Number	:	1053971671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ELIZABETH MONTGOMERY M.ED., BCBA

Provider Business Mailing Address
First Line	:	3423 BEE CAVES RD STE 200
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-7180
Country	:	US
Telephone Number	:	512-524-1374
Fax Number	:	512-524-1355

Provider Business Practice Location Address
First Line	:	3423 BEE CAVES RD STE 200
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-7180
Country	:	US
Telephone Number	:	512-524-1374
Fax Number	:	512-524-1355

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

Provider Enumeration Date	:	06/17/2019
Last Update Date	:	06/17/2019

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