Active NPI
Cindy La-Tische Montgomery, LPC
- Professional Counselor
- Mesa, AZ
National Provider Identifier
1649911579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC-19858
- Practice address
- 4111 E Valley Auto Dr Ste 106
Mesa, AZ 85206-4607 - Phone
- (323) 910-0187
- Fax
- (480) 401-2350
- NPI assigned
- Apr 5, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC-19858 | AZ | Primary |
Addresses
Primary practice location
4111 E Valley Auto Dr Ste 106
Mesa, AZ 85206-4607
Mailing address
1272 N Layman St
Gilbert, AZ 85233-1745
Phone (626) 720-9874
Other names 1
- Cindy La-Tische Gamble
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 9, 2024 through Jan 9, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-19858 | AZ | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656979200000",
"number": "1649911579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1272 N LAYMAN ST",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852331745",
"telephone_number": "626-720-9874"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4111 E VALLEY AUTO DR STE 106",
"city": "MESA",
"state": "AZ",
"postal_code": "852064607",
"telephone_number": "323-910-0187",
"fax_number": "480-401-2350"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONTGOMERY",
"first_name": "CINDY",
"middle_name": "LA-TISCHE",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-04-05",
"last_updated": "2022-07-05",
"certification_date": "2022-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AZ",
"license": "LPC-19858",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "CINDY",
"last_name": "GAMBLE",
"middle_name": "LA-TISCHE",
"credential": "M.ED",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.