MEDICARE: MS. JUDITH B. MARTIN LMFT

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	106H00000X	Marriage & Family Therapist	000895	CT
2	106H00000X	Marriage & Family Therapist	T0883	OR

General Provider Information

NPI Number	:	1912981184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH B. MARTIN LMFT

Provider Business Mailing Address
First Line	:	1892 WILLAMETTE ST
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97401-4044
Country	:	US
Telephone Number	:	541-513-9326
Fax Number	:	541-345-8810

Provider Business Practice Location Address
First Line	:	1892 WILLAMETTE ST
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97401-4044
Country	:	US
Telephone Number	:	541-513-9326
Fax Number	:	541-345-8810

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	11/14/2023

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