Provider Demographics
NPI:1821697384
Name:SIMS, MARTHA (RBT-20-8589-249663)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:SIMS
Suffix:
Gender:F
Credentials:RBT-20-8589-249663
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 S UNIVERSITY BLVD UNIT 307
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5490
Mailing Address - Country:US
Mailing Address - Phone:806-240-5108
Mailing Address - Fax:
Practice Address - Street 1:2450 S UNIVERSITY BLVD UNIT 307
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5490
Practice Address - Country:US
Practice Address - Phone:806-240-5108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-25
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-20-8589-249663106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician