Carmen Knudson-Martin
Individual provider Active NPI Marriage & Family Therapist · Fairview, OR
NPI 1609201615 · NPPES record last updated Sep 10, 2013
Key facts
- NPI
- 1609201615
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- T0736 (OR)
- Practice address
- 21121 NE Shore Dr
Fairview, OR 97024-6762 - Phone
- (909) 262-7725
- NPI assigned
- Sep 10, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40993 | CA | MD | Marriage & Family Therapist |
| MFT000876 | GA | MD | Marriage & Family Therapist |
| T0736 | OR | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | T0736 | OR | Yes |
| Marriage & Family Therapist | 106H00000X | 40993 | CA | |
| Marriage & Family Therapist | 106H00000X | MFT000876 | GA |
Addresses
Primary practice location
21121 NE Shore Dr
Fairview, OR 97024-6762
Mailing address
21121 NE Shore Dr
Fairview, OR 97024-6762
Phone (909) 262-7725
Other names
- Dr. Carmen Ptacek
Other providers in Fairview, OR
- Gary Thomas Ives
- Sarah Christine Johnson
- Yanteunnea Jones
- Tammy Ann Khazali
- Briana Marie Knox
- Philip Kriens
- Rebecca Kuhn
- Brent Labhart
- Laroy Lackey
- Angela Lafontaine
All providers in Fairview, OR · Marriage & Family Therapist in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.