Ellen Paige Montgomery, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4154 Issued in GA

Legal business name

ELLEN PAIGE MONTGOMERY, LLC

Practice address

1807 Over Lake Dr SE
Suite C
Conyers, GA 30013-1777

Phone

(678) 413-3833

Fax

(770) 385-1832

NPI assigned

Oct 14, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Ellen Paige Montgomery, LPC

Title

Owner

Phone

(678) 413-3833

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1255478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255478400000",
    "number": "1871828509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1807 OVER LAKE DR SE",
            "address_2": "SUITE C",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300131777",
            "telephone_number": "678-413-3833",
            "fax_number": "770-385-1832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1807 OVER LAKE DR SE",
            "address_2": "SUITE C",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300131777",
            "telephone_number": "678-413-3833",
            "fax_number": "770-385-1832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLEN PAIGE MONTGOMERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-14",
        "last_updated": "2009-10-14",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "PAIGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-413-3833",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "4154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200566262A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Conyers, GA
• Providers in Conyers, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.