Provider Demographics
NPI:1841781226
Name:MARTI, ELIZABETH ANN
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:MARTI
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 1:47909 232ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-5259
Mailing Address - Country:US
Mailing Address - Phone:612-946-0205
Mailing Address - Fax:612-500-4591
Practice Address - Street 1:47909 232ND ST
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-5259
Practice Address - Country:US
Practice Address - Phone:612-946-0205
Practice Address - Fax:612-500-4591
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01767101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health