Provider Demographics
NPI:1104997667
Name:MONTGOMERY, JEANNE (LMFT)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 CENTURY PKWY NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3154
Mailing Address - Country:US
Mailing Address - Phone:404-633-3347
Mailing Address - Fax:404-325-3663
Practice Address - Street 1:2200 CENTURY PKWY NE
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3154
Practice Address - Country:US
Practice Address - Phone:404-633-3347
Practice Address - Fax:404-325-3663
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT 120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health