Healthcare Provider Details

I. General information

NPI: 1467778126
Provider Name (Legal Business Name): MATTHEW PAUL MARTENS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 HILL HALL UNIVERSITY OF MISSOURI
COLUMBIA MO
65211-2130
US

IV. Provider business mailing address

16 HILL HALL UNIVERSITY OF MISSOURI
COLUMBIA MO
65211-2130
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-3382
  • Fax:
Mailing address:
  • Phone: 573-882-3382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number016122
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: