Provider Demographics
NPI:1558425397
Name:MARTEN, BRAD ALLYN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:ALLYN
Last Name:MARTEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 N TEJON ST
Mailing Address - Street 2:SUITE 303G
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1534
Mailing Address - Country:US
Mailing Address - Phone:719-471-3125
Mailing Address - Fax:719-488-1733
Practice Address - Street 1:19 N TEJON ST
Practice Address - Street 2:SUITE 303G
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1534
Practice Address - Country:US
Practice Address - Phone:719-471-3125
Practice Address - Fax:719-488-1733
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1395103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical