MEDICARE: MS. MICHELLE MONTGOMERY LCSW

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

General Provider Information

NPI Number	:	1700279106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE MONTGOMERY LCSW

Provider Business Mailing Address
First Line	:	6866 JESSICA DR APT SUITE
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97478-8300
Country	:	US
Telephone Number	:	714-222-1020
Fax Number	:

Provider Business Practice Location Address
First Line	:	4328 SE 47TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-4060
Country	:	US
Telephone Number	:	714-222-1020
Fax Number	:

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

Provider Enumeration Date	:	03/09/2015
Last Update Date	:	12/10/2025

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