Provider Demographics
NPI:1518063957
Name:MARTIN, JACQULINE (MS LMFT EMDR I II)
Entity Type:Individual
Prefix:
First Name:JACQULINE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS LMFT EMDR I II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E 29TH STREET
Mailing Address - Street 2:SUITE 290
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538
Mailing Address - Country:US
Mailing Address - Phone:970-217-1152
Mailing Address - Fax:
Practice Address - Street 1:150 E 29TH ST STE 290
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-7804
Practice Address - Country:US
Practice Address - Phone:970-217-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health