Individual
JESSE LOUIS MONTGOMERY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MHPP
Contact information
Practice address
701 ARKANSAS BLVD, TEXARKANA, AR 71854-2105
(870) 772-5028
(870) 772-5056
Mailing address
3352 N FUTRALL DR, FAYETTEVILLE, AR 72703-4057
(479) 521-5868
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/08/2008
Last updated
12/05/2008
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