MEDICARE: DR. MATTHEW PAUL MARTENS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	016122	NY

General Provider Information

NPI Number	:	1467778126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW PAUL MARTENS PH.D.

Provider Business Mailing Address
First Line	:	16 HILL HALL
Second Line	:	UNIVERSITY OF MISSOURI
City	:	COLUMBIA
State	:	MO
Zip	:	65211-2130
Country	:	US
Telephone Number	:	573-882-3382
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 HILL HALL
Second Line	:	UNIVERSITY OF MISSOURI
City	:	COLUMBIA
State	:	MO
Zip	:	65211-2130
Country	:	US
Telephone Number	:	573-882-3382
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2010
Last Update Date	:	04/20/2010

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