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General NPI Number Information
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NPI Number | 1194710863
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Entity Type | Individual
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Provider Name | MARCIA MARIE MIDDEL PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 27TH SPECIAL OPERATIONS MEDICAL GROUP 224 D. L. INGRAM AVE BLD. 1408
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City | CANNON AFB
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State | NM
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Zip | 88103
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Country | US
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Telephone | 575-904-3951
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Fax |
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Provider Business Mailing Address
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Address Line | 675 COBBLE DR
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City | MONTROSE
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State | CO
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Zip | 81403-7813
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Country | US
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Telephone | 720-291-9792
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Fax | 888-537-7171
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1757
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY.0001757
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License Number State |
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