Provider Demographics
NPI:1144381153
Name:MARTIN, MARY (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 S DOWNING ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5822
Mailing Address - Country:US
Mailing Address - Phone:303-778-5774
Mailing Address - Fax:303-778-2436
Practice Address - Street 1:2465 S DOWNING ST
Practice Address - Street 2:SUITE 110
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5822
Practice Address - Country:US
Practice Address - Phone:303-778-5774
Practice Address - Fax:303-778-2436
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO804101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO804OtherLPC LICENSE