Provider Demographics
NPI:1770527905
Name:J. COLBY MARTIN, PH.D., P.C.
Entity type:Organization
Organization Name:J. COLBY MARTIN, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:COLBY
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-355-9933
Mailing Address - Street 1:29 S. WEBSTER STREET
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-4563
Mailing Address - Country:US
Mailing Address - Phone:630-355-9933
Mailing Address - Fax:
Practice Address - Street 1:29 S WEBSTER ST
Practice Address - Street 2:SUITE 220
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5356
Practice Address - Country:US
Practice Address - Phone:630-355-9933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health