Martina Jane Nelson, LCSW, LAC,CMHP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

799 Issued in MT

Practice address

603 California Ave
Libby, MT 59923-1901

Phone

(406) 293-7116

Fax

(406) 293-8119

NPI assigned

Aug 3, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Martina Jane Boothman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258070400000",
    "number": "1922015536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 CALIFORNIA AVENUE",
            "city": "LIBBY",
            "state": "MT",
            "postal_code": "59923",
            "telephone_number": "406-293-7116",
            "fax_number": "406-293-8119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 CALIFORNIA AVE",
            "city": "LIBBY",
            "state": "MT",
            "postal_code": "599231901",
            "telephone_number": "406-293-7116",
            "fax_number": "406-293-8119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "MARTINA",
        "middle_name": "JANE",
        "credential": "LCSW, LAC,CMHP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-03",
        "last_updated": "2009-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MT",
            "license": "954",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MT",
            "license": "799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0044707",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARTINA",
            "last_name": "BOOTHMAN",
            "middle_name": "JANE",
            "credential": "LCPC, LAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Clinical Social Worker in Libby, MT
• Providers in Libby, MT by specialty
• Clinical Social Worker in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.