Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301012698 | MI |
Y | 103T00000X | Psychologist | 6301012698 | MI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6301012698 | MI |
N | 103G00000X | Clinical Psychologist | 6301012698 | MI |
N | 103TC0700X | Clinical Psychologist | 6301012698 | MI |
N | 103TH0004X | Health Psychologist | 6301012698 | MI |
N | 103TH0100X | Health Service | 6301012698 | |
N | 103TP2701X | Group Psychotherapist | 6301012698 | MI |
N | 103TR0400X | Rehabilitation Psychologist | 6301012698 | MI |
NPI | 1700159670 |
---|---|
Provider Name | Heidi Baird Martin |
First Address | Birmingham, MI 48009-2029 |
Second Address | Birmingham, MI 48009-2029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2012 |
Last Update Date | 23/02/2018 |