MEDICARE: REBECCA MONTGOMERY

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1992449979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA MONTGOMERY

Provider Business Mailing Address
First Line	:	405 E FAIRLANE DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-7207
Country	:	US
Telephone Number	:	605-307-3883
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 E FAIRLANE DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-7207
Country	:	US
Telephone Number	:	605-307-3883
Fax Number	:

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

Provider Enumeration Date	:	04/25/2022
Last Update Date	:	04/21/2026

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Directions to “ REBECCA MONTGOMERY ” Practice Location

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