Basic Information
| Provider Information | |||||||||
| NPI: | 1861460388 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTGOMERY | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPCC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 4015 SR 377 | ||||||||
| Address2: | |||||||||
| City: | STOCKPORT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405573511 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2845 BELL ST | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437011720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404549766 | ||||||||
| FaxNumber: | 7405886452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E514 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 131501 | 01 | OH | MOUNT CARMEL PIN | OTHER | 000000218885 | 01 | OH | ANTHEM PIN | OTHER | 131502 | 01 | OH | MOUNT CARMEL PIN | OTHER | Y147346 | 01 | OH | THE HEALTH PLAN PIN | OTHER | 142267 | 01 | OH | COMPPSYCH BH PIN | OTHER | 212250 | 01 | OH | TRICARE/MHN PIN | OTHER | 7636250 | 01 | OH | AETNA PIN | OTHER | 2032247 | 01 | OH | CIGNA PIN | OTHER | 3730 | 01 | OH | FEI BH PIN | OTHER | 131503 | 01 | OH | MOUNT CARMEL PIN | OTHER | 6207975 | 01 | OH | UNITED BH PIN | OTHER |