Provider Demographics
NPI:1285303131
Name:AULL, MARTHA
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:AULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 SARAH LN APT 106
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5607
Mailing Address - Country:US
Mailing Address - Phone:314-853-0521
Mailing Address - Fax:
Practice Address - Street 1:567 SARAH LN APT 106
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5607
Practice Address - Country:US
Practice Address - Phone:314-853-0521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021034905101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health