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General NPI Number Information
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NPI Number | 1912429796
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Entity Type | Individual
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Provider Name | MARTHA ANNE BIASTOCH MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 04/17/2019
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Provider Practice Location Address
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Address Line | 3220 N ACADEMY BLVD STE 3
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City | COLORADO SPRINGS
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State | CO
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Zip | 80917-5115
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Country | US
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Telephone | 303-601-3032
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Fax |
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Provider Business Mailing Address
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Address Line | 7170 S WENATCHEE WAY UNIT B
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City | AURORA
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State | CO
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Zip | 80016-4066
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Country | US
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Telephone | 303-601-3032
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | NLC.0106113
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0015354
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License Number State | CO
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