MEDICARE: MRS. CHARLOTTE CAREY MONTGOMERY LPC

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	101YM0800X	Mental Health Counselor	13650	TX

General Provider Information

NPI Number	:	1689740441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARLOTTE CAREY MONTGOMERY LPC

Provider Business Mailing Address
First Line	:	1110 N LOOP 336 W
Second Line	:	SUITE 530
City	:	CONROE
State	:	TX
Zip	:	77301-1193
Country	:	US
Telephone Number	:	936-273-0863
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 N LOOP 336 W
Second Line	:	SUITE 530
City	:	CONROE
State	:	TX
Zip	:	77301-1193
Country	:	US
Telephone Number	:	936-273-0863
Fax Number	:

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

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	07/08/2007

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