Provider Demographics
NPI:1386203115
Name:MARTIN, HEATHER ROSE (MA, MS)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ROSE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HAMPTONRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6638
Mailing Address - Country:US
Mailing Address - Phone:405-612-5061
Mailing Address - Fax:
Practice Address - Street 1:307 E DANFORTH RD STE 124
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4484
Practice Address - Country:US
Practice Address - Phone:405-726-8966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor