Provider Demographics
NPI:1578360020
Name:MONTGOMERY MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:MONTGOMERY MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:812-767-2334
Mailing Address - Street 1:3375 BRENT CROSS
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-2456
Mailing Address - Country:US
Mailing Address - Phone:812-767-2334
Mailing Address - Fax:
Practice Address - Street 1:2225 CENTRAL AVE STE 3
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-4488
Practice Address - Country:US
Practice Address - Phone:812-767-2334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty