Provider Demographics
NPI:1083756688
Name:HARWELL, MARTHA SMITH (MS)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:SMITH
Last Name:HARWELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 GOLDFIELD CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-6633
Mailing Address - Country:US
Mailing Address - Phone:731-660-8048
Mailing Address - Fax:
Practice Address - Street 1:24 WEATHERFORD SQ
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2202
Practice Address - Country:US
Practice Address - Phone:731-660-6760
Practice Address - Fax:731-984-6209
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health