Provider Demographics
NPI:1679092977
Name:BAUTISTA-BIDDLE, MARTHA MIDDLETON (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:MIDDLETON
Last Name:BAUTISTA-BIDDLE
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#415, 4800 BASELINE RD STE E104
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303
Mailing Address - Country:US
Mailing Address - Phone:720-340-3441
Mailing Address - Fax:
Practice Address - Street 1:1658 YORK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1410
Practice Address - Country:US
Practice Address - Phone:303-935-5307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
COPSY.0006194103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health