Individual
PHYLLIS MONTGOMERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
323 12TH AVE RD, NAMPA, ID 83686-5014
(208) 463-0212
(208) 461-5452
Mailing address
323 12TH AVE RD, NAMPA, ID 83686-5014
(208) 463-0212
(208) 461-5452
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW 712
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002743500
—
ID
Enumeration date
06/05/2008
Last updated
06/05/2008
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