Provider Demographics
NPI:1306153846
Name:MARTIN, OLIVIA D (PSYD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:D
Last Name:MARTIN
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 1:3434 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1812
Mailing Address - Country:US
Mailing Address - Phone:619-281-3706
Mailing Address - Fax:619-281-3714
Practice Address - Street 1:600 CENTRAL AVE STE 225
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3157
Practice Address - Country:US
Practice Address - Phone:062-011-4854
Practice Address - Fax:406-403-0312
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPS2011116101YM0800X
MT67872101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health