Healthcare Provider Details

I. General information

NPI: 1659507614
Provider Name (Legal Business Name): MARTHA BOMBOY PHARR M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750A SOUTHLAND DR
MOBILE AL
36693-3316
US

IV. Provider business mailing address

5750A SOUTHLAND DR
MOBILE AL
36693-3316
US

V. Phone/Fax

Practice location:
  • Phone: 251-824-2310
  • Fax:
Mailing address:
  • Phone: 251-824-2310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3013
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10256
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: