Healthcare Provider Details

I. General information

NPI: 1700159670
Provider Name (Legal Business Name): HEIDI BAIRD MARTIN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 SMITH AVE
BIRMINGHAM MI
48009-2029
US

IV. Provider business mailing address

676 SMITH AVE
BIRMINGHAM MI
48009-2029
US

V. Phone/Fax

Practice location:
  • Phone: 248-497-5166
  • Fax:
Mailing address:
  • Phone: 248-497-5166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6301012698
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301012698
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number6301012698
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number6301012698
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number6301012698
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number6301012698
License Number StateMI
# 7
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301012698
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: