Provider Demographics
NPI:1578809042
Name:MARTINY-YSSEL, BRITA (PHD)
Entity Type:Individual
Prefix:
First Name:BRITA
Middle Name:
Last Name:MARTINY-YSSEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:BRITA
Other - Middle Name:
Other - Last Name:MARTINY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2150 SANTA FE SPGS
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-6214
Mailing Address - Country:US
Mailing Address - Phone:928-460-5887
Mailing Address - Fax:
Practice Address - Street 1:119 E GOODWIN ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-3940
Practice Address - Country:US
Practice Address - Phone:928-899-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY1446103T00000X
NVPY0681103T00000X
CAPSY12691103T00000X
AZ# 4730103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY12691OtherPSYCHOLOGY LICENSE
NVPY0681OtherPSYCHOLOGY LICENSES
HIPSY1446OtherPSYCHOLOGIST LICENSE
AZ4730OtherARIZONA PSYCHOLOGY LICENSE