Healthcare Provider Details

I. General information

NPI: 1457760886
Provider Name (Legal Business Name): RACHEL MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 FULLER AVE STE 5
HELENA MT
59601-3394
US

IV. Provider business mailing address

PO BOX 120
CLANCY MT
59634-0120
US

V. Phone/Fax

Practice location:
  • Phone: 406-410-3212
  • Fax:
Mailing address:
  • Phone: 406-410-3212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberBBH-LMFT-LIC-53058
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number123236
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: