Provider Demographics
NPI:1215182118
Name:MONROE, MARTHA ARLEEN (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ARLEEN
Last Name:MONROE
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:DR
Other - First Name:MARTI
Other - Middle Name:
Other - Last Name:MONROE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPDA, REV
Mailing Address - Street 1:1797 W FLOATING FEATHER RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-3717
Mailing Address - Country:US
Mailing Address - Phone:208-938-1339
Mailing Address - Fax:
Practice Address - Street 1:1797 W FLOATING FEATHER RD
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-3717
Practice Address - Country:US
Practice Address - Phone:208-938-1339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-2763106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist