MEDICARE: DR. MARTHA DRAKE YOUNG 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	103TC0700X	Clinical Psychologist	840	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548204076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA DRAKE YOUNG PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 773805
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80477-3805
Country	:	US
Telephone Number	:	970-879-7637
Fax Number	:	970-871-6811

Provider Business Practice Location Address
First Line	:	810 LINCOLN AVE
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-4972
Country	:	US
Telephone Number	:	970-879-7637
Fax Number	:	970-871-6811

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/09/2007

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