Provider Demographics
NPI:1003394065
Name:LANDERS, MARTHA (MHR)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:LANDERS
Suffix:
Gender:F
Credentials:MHR
Other - Prefix:
Other - First Name:MARTY
Other - Middle Name:
Other - Last Name:LANDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MHR
Mailing Address - Street 1:1403 F ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1403 F ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4138
Practice Address - Country:US
Practice Address - Phone:541-780-6213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health