Healthcare Provider Details

I. General information

NPI: 1982520961
Provider Name (Legal Business Name): ALEXIS MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 N MICHIGAN ST
PITTSBURG KS
66762-2545
US

IV. Provider business mailing address

3103 N MICHIGAN ST
PITTSBURG KS
66762-2545
US

V. Phone/Fax

Practice location:
  • Phone: 620-235-7180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: