Individual
SAMUEL AUSTIN MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
110 TREALOUT DR STE 103, FENTON, MI 48430-1402
(248) 812-9046
Mailing address
6901 CHESTERFIELD, WATERFORD, MI 48327-3528
(248) 464-3287
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
6451021910
MI
103T00000X
Psychologist
Primary
6362009401
MI
Other
Enumeration date
03/09/2022
Last updated
03/09/2022
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