Provider Demographics
NPI:1952561508
Name:WESTBROOK, MARTHA
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:
Last Name:WESTBROOK
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 1:111 PRINCESS TRL
Mailing Address - Street 2:
Mailing Address - City:LOOKOUT MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30750-2817
Mailing Address - Country:US
Mailing Address - Phone:706-820-1358
Mailing Address - Fax:706-820-2304
Practice Address - Street 1:150 DEBRA RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5616
Practice Address - Country:US
Practice Address - Phone:423-893-6557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000845101YP2500X
TN0000093443163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163W00000XNursing Service ProvidersRegistered Nurse