Montgomery, Phyllis
Montgomery, Phyllis is an sole proprietor health care provider with primary practice located at 323 12Th Ave Rd , Nampa ID 83686-5014. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Montgomery, Phyllis can be contacted via phone (208) 463-0212.Contact Information
Primary practice address
323 12Th Ave Rd
Nampa ID 83686-5014
Phone: (208) 463-0212
Fax: (208) 461-5452
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | LCSW 712 | Idaho |
Profile Details
| NPI number | 1316106107 |
|---|---|
| LBN Legal business name | Montgomery, Phyllis |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 5th, 2008 |
| Last updated | Jun 5th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1316106107 | NPPES |
| Idaho | MEDICAID | 002743500 |
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