=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952561508
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. MARTHA WESTBROOK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2008
-----------------------------------------------------
Last Update Date | 06/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 DEBRA RD
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37411-5616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-893-6557
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 PRINCESS TRL
-----------------------------------------------------
City | LOOKOUT MOUNTAIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30750-2817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-820-1358
-----------------------------------------------------
Fax | 706-820-2304
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 0000000845
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 0000093443
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------