Healthcare Provider Details

I. General information

NPI: 1356701122
Provider Name (Legal Business Name): KAREN MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SE 2ND STREET
PENDLETON OR
97801
US

IV. Provider business mailing address

702 SUNSET DR
ONTARIO OR
97914-3121
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-4607
  • Fax:
Mailing address:
  • Phone: 541-889-9167
  • Fax: 541-889-7873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1932295326
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: