MEDICARE: MARTIN PSYCHOLOGY GROUP L.L.C.

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	101YP2500X	Professional Counselor
2	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1548908478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTIN PSYCHOLOGY GROUP L.L.C.

Provider Business Mailing Address
First Line	:	3030 S COLLEGE AVE UNIT 207
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2557
Country	:	US
Telephone Number	:	970-399-9950
Fax Number	:	970-825-1895

Provider Business Practice Location Address
First Line	:	3030 S COLLEGE AVE UNIT 207
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2557
Country	:	US
Telephone Number	:	970-399-9950
Fax Number	:	970-825-1895

Authorized Official
Title or Position	:	CO-OWNER, LPC
Name	:	MATTHEW MARTIN
Credential	:	LPC
Telephone Number	:	970-230-3770

Provider Enumeration Date	:	05/20/2022
Last Update Date	:	11/15/2022

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