Provider Demographics
NPI:1841314861
Name:HOMME, MARTHA WILLIAMS (MA)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:WILLIAMS
Last Name:HOMME
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 DUTCH LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:HOWARD LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55349-5135
Mailing Address - Country:US
Mailing Address - Phone:320-543-2792
Mailing Address - Fax:
Practice Address - Street 1:123 DUTCH LAKE TRL
Practice Address - Street 2:
Practice Address - City:HOWARD LAKE
Practice Address - State:MN
Practice Address - Zip Code:55349-5135
Practice Address - Country:US
Practice Address - Phone:320-543-2792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4582101YP2500X
MN00111101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional