Healthcare Provider Details

I. General information

NPI: 1134039563
Provider Name (Legal Business Name): LINDSEY AUTUMN MARTIN CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3288 E PINE AVE
MERIDIAN ID
83642-5922
US

IV. Provider business mailing address

3288 E PINE AVE
MERIDIAN ID
83642-5922
US

V. Phone/Fax

Practice location:
  • Phone: 208-888-8887
  • Fax: 208-658-0153
Mailing address:
  • Phone: 208-888-8887
  • Fax: 208-658-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: