Provider Demographics
NPI:1124647383
Name:MARCIA M. MIDDEL
Entity type:Organization
Organization Name:MARCIA M. MIDDEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIDDEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-234-5081
Mailing Address - Street 1:2233 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3831
Mailing Address - Country:US
Mailing Address - Phone:970-765-0818
Mailing Address - Fax:970-497-8410
Practice Address - Street 1:1544 OXBOW DR STE 223
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5189
Practice Address - Country:US
Practice Address - Phone:970-234-5081
Practice Address - Fax:888-537-7171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty