Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 2730 | OR |
N | 103T00000X | Psychologist | 2730 | OR |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 2730 | OR |
Y | 103TF0200X | Forensic Psychologist | 2730 | OR |
NPI | 1053838581 |
---|---|
Provider Name | Dr. Breann Nicole Martin |
First Address | Eugene, OR 97404-1679 |
Second Address | Eugene, OR 97404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2017 |
Last Update Date | 25/08/2017 |