Provider Demographics
NPI:1346615465
Name:HATCH, MARTEN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARTEN
Middle Name:
Last Name:HATCH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:MARTEN
Other - Middle Name:ARVIL
Other - Last Name:HATCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4030 E 480 N
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5207
Mailing Address - Country:US
Mailing Address - Phone:208-346-3377
Mailing Address - Fax:
Practice Address - Street 1:452 D ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3531
Practice Address - Country:US
Practice Address - Phone:208-552-0355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-35278104100000X
IDLCSW-376381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker