Provider Demographics
NPI:1558557843
Name:MARTHA SUTHERLAND, PSYD, PLLC
Entity Type:Organization
Organization Name:MARTHA SUTHERLAND, PSYD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:STEVE
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:970-587-8929
Mailing Address - Street 1:19 OLD TOWN SQ
Mailing Address - Street 2:SUITE 238
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2471
Mailing Address - Country:US
Mailing Address - Phone:970-587-8929
Mailing Address - Fax:
Practice Address - Street 1:19 OLD TOWN SQ
Practice Address - Street 2:SUITE 238
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2471
Practice Address - Country:US
Practice Address - Phone:970-587-8929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2716251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1750425831OtherINDIVIDUAL NPI FOR DR. SUTHERLAND
COCO 810099Medicare UPIN
COCO 810098Medicare UPIN