MEDICARE: KATRINA S MARTIN MS, LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC-1271	WY

General Provider Information

NPI Number	:	1689983611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA S MARTIN MS, LPC, NCC

Provider Business Mailing Address
First Line	:	2020 E GRAND AVE STE 410
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-4380
Country	:	US
Telephone Number	:	307-399-7437
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 E GRAND AVE STE 410
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-4380
Country	:	US
Telephone Number	:	307-399-7437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2010
Last Update Date	:	05/17/2019

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