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General NPI Number Information
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NPI Number | 1629107156
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Entity Type | Individual
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Provider Name | MARTHA JEAN COULTER M.ED.
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Gender | Female
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 11/14/2009
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Provider Practice Location Address
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Address Line | 128 MERCHANTS ROW 6TH FLOOR
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City | RUTLAND
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State | VT
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Zip | 05701-5909
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Country | US
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Telephone | 802-773-1411
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Fax | 802-775-7319
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Provider Business Mailing Address
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Address Line | 257 S. MAIN ST. RCSU
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City | RUTLAND
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State | VT
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Zip | 05701
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Country | US
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Telephone | 802-773-1411
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Fax | 802-775-7319
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 000194-1
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License Number State | NY
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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 | 0470000386
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State | VT
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