| Nathan Lane Montgomery Foundation, Inc. | |
|
3570 E 12th Ave Ste 102 Denver CO 80206-3431 | |
| (720) 319-3079 | |
| Not Available |
| Full Name | Nathan Lane Montgomery Foundation, Inc. |
|---|---|
| Speciality | Counselor |
| Location | 3570 E 12th Ave Ste 102, Denver, Colorado |
| Authorized Official Name and Position | Hollie Hoyle (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 7203193079 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nathan Lane Montgomery Foundation, Inc. 3570 E 12th Ave Ste 102 Denver CO 80206-3431 Ph: (720) 319-3079 | Nathan Lane Montgomery Foundation, Inc. 3570 E 12th Ave Ste 102 Denver CO 80206-3431 Ph: (720) 319-3079 |
| NPI Number | 1801574900 |
|---|---|
| Provider Enumeration Date | 07/07/2023 |
| Last Update Date | 07/24/2023 |
| Certification Date | 07/24/2023 |
| Medicare PECOS PAC ID | 9537511043 |
|---|---|
| Medicare Enrollment ID | O20240121000051 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801574900 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Katherine Ferrara |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164745659 PECOS PAC ID: 5193984201 Enrollment ID: I20120309000052 |
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