Provider Demographics
NPI:1306112974
Name:DAVIS, MARTHA M (PSYD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6919 E. 10TH STREET
Mailing Address - Street 2:SUITE C-4
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4811
Mailing Address - Country:US
Mailing Address - Phone:317-354-8401
Mailing Address - Fax:317-354-8201
Practice Address - Street 1:6919 E. 10TH STREET
Practice Address - Street 2:SUITE C-4
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-4811
Practice Address - Country:US
Practice Address - Phone:317-354-8401
Practice Address - Fax:317-354-8201
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent