Provider Demographics
NPI:1831293844
Name:MARTIN, MARIAN FOWERS (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:FOWERS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 NORTH 30TH STREET
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0732
Mailing Address - Country:US
Mailing Address - Phone:406-252-0011
Mailing Address - Fax:406-245-7074
Practice Address - Street 1:1018 NORTH 30TH STREET
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0732
Practice Address - Country:US
Practice Address - Phone:406-252-0011
Practice Address - Fax:406-245-7074
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT53103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT492557Medicaid
MT51330OtherBLUE CROSS BLUE SHIELD
MT492557Medicaid