MEDICARE: MARTHA SUTHERLAND, PSYD, PLLC

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	251S00000X	Community/Behavioral Health Agency	2716	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1750425831	OTHER	CO	INDIVIDUAL NPI FOR DR. SUTHERLAND

General Provider Information

NPI Number	:	1558557843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTHA SUTHERLAND, PSYD, PLLC

Provider Business Mailing Address
First Line	:	19 OLD TOWN SQ
Second Line	:	SUITE 238
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2471
Country	:	US
Telephone Number	:	970-587-8929
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 OLD TOWN SQ
Second Line	:	SUITE 238
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2471
Country	:	US
Telephone Number	:	970-587-8929
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. MARTHA STEVE SUTHERLAND
Credential	:	PSYD
Telephone Number	:	970-587-8929

Provider Enumeration Date	:	09/20/2007
Last Update Date	:	11/08/2022

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