Provider Demographics
NPI:1699455097
Name:MONTGOMERY, RONALD TYLER (LGPC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:TYLER
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 N BROOM ST APT 7
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-3160
Mailing Address - Country:US
Mailing Address - Phone:410-688-2311
Mailing Address - Fax:
Practice Address - Street 1:306 W PULASKI HWY
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5217
Practice Address - Country:US
Practice Address - Phone:410-686-3629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health