Healthcare Provider Details

I. General information

NPI: 1114834835
Provider Name (Legal Business Name): MARLA MARTIN PSYD, LP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 S STUART AVE
GILBERT AZ
85295-9121
US

IV. Provider business mailing address

PO BOX 333
GILBERT AZ
85299-0333
US

V. Phone/Fax

Practice location:
  • Phone: 425-864-0950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MARLA MARTIN
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSYD, LP
Phone: 425-864-0950