Provider Demographics
NPI:1346034477
Name:MONTGOMERY CHRISTIAN COUNSELING, LLC
Entity type:Organization
Organization Name:MONTGOMERY CHRISTIAN COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC, LPC
Authorized Official - Phone:801-866-8984
Mailing Address - Street 1:611 CRESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1709
Mailing Address - Country:US
Mailing Address - Phone:801-844-1003
Mailing Address - Fax:
Practice Address - Street 1:1436 S LEGEND HILLS DR STE 335
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-2187
Practice Address - Country:US
Practice Address - Phone:801-444-1003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty