Provider Demographics
NPI:1083672349
Name:KETCHEL, MARTA F (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:F
Last Name:KETCHEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 N SWAN RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1225
Mailing Address - Country:US
Mailing Address - Phone:520-323-3156
Mailing Address - Fax:520-325-4224
Practice Address - Street 1:3060 N SWAN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1225
Practice Address - Country:US
Practice Address - Phone:520-323-3156
Practice Address - Fax:520-325-4224
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0382103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPHD382Medicare ID - Type Unspecified