Provider Demographics
NPI:1710923032
Name:MARKT, CHARLA (PSYD)
Entity Type:Individual
Prefix:
First Name:CHARLA
Middle Name:
Last Name:MARKT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 EDMOND ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64501-2702
Mailing Address - Country:US
Mailing Address - Phone:816-364-4300
Mailing Address - Fax:816-279-8148
Practice Address - Street 1:902 EDMOND ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64501-2702
Practice Address - Country:US
Practice Address - Phone:816-364-4300
Practice Address - Fax:816-279-8148
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003024040103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499234409Medicaid
MOC980379Medicare PIN