MEDICARE: MS. KRISTEN AUBERRY MARTIN MA/MS

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	106H00000X	Marriage & Family Therapist	2014-002	KY
2	106H00000X	Marriage & Family Therapist	169250	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770993859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTEN AUBERRY MARTIN MA/MS

Provider Business Mailing Address
First Line	:	620 EUCLID AVE STE 203
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-6429
Country	:	US
Telephone Number	:	859-705-8075
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 EUCLID AVE STE 203
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-6429
Country	:	US
Telephone Number	:	859-705-8075
Fax Number	:

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

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	01/07/2021

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