Provider Demographics
NPI:1902207376
Name:MONTGOMERY, ROBERT (MFT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-2941
Mailing Address - Country:US
Mailing Address - Phone:205-886-6619
Mailing Address - Fax:
Practice Address - Street 1:6619 DUNBARTON DR
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2920
Practice Address - Country:US
Practice Address - Phone:205-886-6619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL426106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty