Provider Demographics
NPI:1467778126
Name:MARTENS, MATTHEW PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PAUL
Last Name:MARTENS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HILL HALL
Mailing Address - Street 2:UNIVERSITY OF MISSOURI
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65211-2130
Mailing Address - Country:US
Mailing Address - Phone:573-882-3382
Mailing Address - Fax:
Practice Address - Street 1:16 HILL HALL
Practice Address - Street 2:UNIVERSITY OF MISSOURI
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65211-2130
Practice Address - Country:US
Practice Address - Phone:573-882-3382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016122103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling