Healthcare Provider Details

I. General information

NPI: 1033778105
Provider Name (Legal Business Name): STEPHEN MARTEN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 S MAIN ST STE 109
CEDAR CITY UT
84720-3337
US

IV. Provider business mailing address

4125 N DRIFTWOOD LN
ENOCH UT
84721-7041
US

V. Phone/Fax

Practice location:
  • Phone: 406-304-7069
  • Fax:
Mailing address:
  • Phone: 406-304-7069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11694219-3902
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-LPCP-LIC-38064
License Number StateMT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: