Provider Demographics
NPI:1972722882
Name:MARTEN, LINDA MAE (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:MAE
Last Name:MARTEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 GATEWAY BLVD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3572
Mailing Address - Country:US
Mailing Address - Phone:972-644-5511
Mailing Address - Fax:972-644-5512
Practice Address - Street 1:1701 GATEWAY BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3572
Practice Address - Country:US
Practice Address - Phone:972-644-5511
Practice Address - Fax:972-644-5512
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC 4845101YP2500X
TXLMFT 3541106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXLP0010309Medicaid