Provider Demographics
NPI:1598382053
Name:MCDERMOTT, MONTANA JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:MONTANA
Middle Name:JEAN
Last Name:MCDERMOTT
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:MONTANA
Other - Middle Name:JEAN
Other - Last Name:YATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3938 CONLEY LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-2009
Mailing Address - Country:US
Mailing Address - Phone:865-226-9882
Mailing Address - Fax:
Practice Address - Street 1:3938 CONLEY LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2009
Practice Address - Country:US
Practice Address - Phone:865-226-9882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12645104100000X
TN87721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker