Provider Demographics
NPI:1174018691
Name:MARTIN, ALANDA SEA
Entity Type:Individual
Prefix:
First Name:ALANDA
Middle Name:SEA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 E 8TH AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5708
Mailing Address - Country:US
Mailing Address - Phone:970-317-0667
Mailing Address - Fax:
Practice Address - Street 1:270 E 8TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5708
Practice Address - Country:US
Practice Address - Phone:970-317-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5229101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty