Provider Demographics
NPI:1174361042
Name:MONTGOMERY, ANNA LAUREN (RBT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:LAUREN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CHANCEY DR
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-3345
Mailing Address - Country:US
Mailing Address - Phone:334-733-2911
Mailing Address - Fax:
Practice Address - Street 1:807 DONNELL BLVD STE M
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36322-2111
Practice Address - Country:US
Practice Address - Phone:334-709-4024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALBACB1133090251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health