MEDICARE: DR. TIFFANI MARTIN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	13664	CO

General Provider Information

NPI Number	:	1497102933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIFFANI MARTIN PHD

Provider Business Mailing Address
First Line	:	305 W SOUTH 1ST ST
Second Line	:
City	:	JOHNSTOWN
State	:	CO
Zip	:	80534-9086
Country	:	US
Telephone Number	:	970-231-2681
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 W SOUTH 1ST ST
Second Line	:
City	:	JOHNSTOWN
State	:	CO
Zip	:	80534-9086
Country	:	US
Telephone Number	:	970-231-2681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2016
Last Update Date	:	05/13/2016

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Directions to “ DR. TIFFANI MARTIN PHD” Practice Location

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