MEDICARE: CHARLES 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	101YP2500X	Professional Counselor	3786	AL

General Provider Information

NPI Number	:	1841787967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES MONTGOMERY LPC

Provider Business Mailing Address
First Line	:	190 LIME QUARRY RD STE 212
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-8976
Country	:	US
Telephone Number	:	512-569-5328
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 LIME QUARRY RD STE 212
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-8976
Country	:	US
Telephone Number	:	512-569-5328
Fax Number	:

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

Provider Enumeration Date	:	04/13/2018
Last Update Date	:	04/13/2018

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Directions to “ CHARLES MONTGOMERY LPC” Practice Location

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