Provider Demographics
NPI:1902559834
Name:MARTIN, SHILO MARIE (QMHA)
Entity Type:Individual
Prefix:
First Name:SHILO
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 MACE RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-1280
Mailing Address - Country:US
Mailing Address - Phone:541-500-1202
Mailing Address - Fax:
Practice Address - Street 1:248 MACE RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-1280
Practice Address - Country:US
Practice Address - Phone:541-500-1202
Practice Address - Fax:541-631-3424
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health