MEDICARE: NATHAN LANE MONTGOMERY FOUNDATION, INC.

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	:	1801574900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATHAN LANE MONTGOMERY FOUNDATION, INC.

Provider Business Mailing Address
First Line	:	3570 E 12TH AVE STE 102
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-3431
Country	:	US
Telephone Number	:	720-319-3079
Fax Number	:

Provider Business Practice Location Address
First Line	:	3570 E 12TH AVE STE 102
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-3431
Country	:	US
Telephone Number	:	720-319-3079
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	HOLLIE HOYLE
Credential	:
Telephone Number	:	720-319-3079

Provider Enumeration Date	:	07/07/2023
Last Update Date	:	07/24/2023

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