Provider Demographics
NPI:1932186533
Name:TEATER, MARTHA (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:TEATER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9463 E 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238
Mailing Address - Country:US
Mailing Address - Phone:828-734-6212
Mailing Address - Fax:828-333-5592
Practice Address - Street 1:9463 E 52ND AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238
Practice Address - Country:US
Practice Address - Phone:828-734-6212
Practice Address - Fax:828-333-5592
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC472106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102268Medicaid
2578503Medicare PIN
NCC86724Medicare UPIN