Active NPI
Susan Martin, LMFT
- Marriage & Family Therapist
- Eagle, ID
National Provider Identifier
1275000978
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 8352
- Practice address
- 380 W. State St.
Eagle, ID 83616 - Phone
- (208) 629-7730
- NPI assigned
- Oct 31, 2018
- Last updated
- Jan 12, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 110172 | CA | |
| Marriage & Family Therapist | 106H00000X | 8352 | ID | Primary |
Addresses
Primary practice location
380 W. State St.
Eagle, ID 83616
Mailing address
PO Box 140514
Garden City, ID 83714
Phone (916) 780-1059
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8352 | ID | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Susan Martin Therapy and Wellness PLLC | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- Boise, ID
- NPI 1245948819
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641945600000",
"number": "1275000978",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 140514",
"city": "GARDEN CITY",
"state": "ID",
"postal_code": "83714",
"telephone_number": "916-780-1059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "380 W. STATE ST.",
"city": "EAGLE",
"state": "ID",
"postal_code": "83616",
"telephone_number": "208-629-7730"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "SUSAN",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-31",
"last_updated": "2022-01-12",
"certification_date": "2022-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "110172",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "ID",
"license": "8352",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eagle, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.