MEDICARE: MONTGOMERY COUNSELING CENTER LLC

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	106H00000X	Marriage & Family Therapist	393	AL

General Provider Information

NPI Number	:	1124437199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY COUNSELING CENTER LLC

Provider Business Mailing Address
First Line	:	8131 OLD FEDERAL RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-8009
Country	:	US
Telephone Number	:	334-590-7489
Fax Number	:	334-277-6791

Provider Business Practice Location Address
First Line	:	8131 OLD FEDERAL RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-8009
Country	:	US
Telephone Number	:	334-590-7489
Fax Number	:	334-277-6791

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. BRANDI MCNEW
Credential	:	LMFT
Telephone Number	:	334-590-7489

Provider Enumeration Date	:	08/04/2014
Last Update Date	:	08/04/2014

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