Provider Information for 1952049553
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ALYSSA MARIE MONTGOMERY LCSW
Sex: Female
NPI: 1952049553
Last Updated: 2023-09-08
Certification Date: 2022-07-20
Certification Date: 2022-07-20
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1952049553 | ||||||||
| Enumeration Date | 2022-05-24 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 8873 S MEADOW LN OWENSVILLE, IN 47665-8865 United States Phone: 317-966-4038 | Fax: | ||||||||
| Primary Practice Address | 650 JOEL DR FORT CAMPBELL, KY 42223-5318 United States Phone: 317-966-4038 | Fax: | ||||||||
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