Healthcare Provider Details

I. General information

NPI: 1679092977
Provider Name (Legal Business Name): MARTHA MIDDLETON BAUTISTA-BIDDLE PSYD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 10/05/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1658 YORK ST
DENVER CO
80206-1410
US

IV. Provider business mailing address

#415, 4800 BASELINE RD STE E104
BOULDER CO
80303
US

V. Phone/Fax

Practice location:
  • Phone: 303-935-5307
  • Fax:
Mailing address:
  • Phone: 720-340-3441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0006194
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: