Provider Demographics
NPI:1164756888
Name:COLE, MARTHA (LMSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-0055
Mailing Address - Country:US
Mailing Address - Phone:505-426-4405
Mailing Address - Fax:
Practice Address - Street 1:1302 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401
Practice Address - Country:US
Practice Address - Phone:575-461-2200
Practice Address - Fax:575-461-2213
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-06273104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker