Provider Demographics
NPI:1881108116
Name:HARPER, MARTINI
Entity type:Individual
Prefix:
First Name:MARTINI
Middle Name:
Last Name:HARPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4254 W OUTER DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-1462
Mailing Address - Country:US
Mailing Address - Phone:313-283-9476
Mailing Address - Fax:
Practice Address - Street 1:4254 W OUTER DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-1462
Practice Address - Country:US
Practice Address - Phone:313-283-9476
Practice Address - Fax:313-283-9476
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI82-3488386OtherMENTAL
MI82-3488386OtherMENTAL HEALTH