Healthcare Provider Details

I. General information

NPI: 1407621113
Provider Name (Legal Business Name): KATHERINE MEGAN MARTIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 W STAN SCHLUETER LOOP STE 100
KILLEEN TX
76549-6691
US

IV. Provider business mailing address

1103 W STAN SCHLUETER LOOP STE 100
KILLEEN TX
76549-6691
US

V. Phone/Fax

Practice location:
  • Phone: 254-213-7847
  • Fax: 254-312-2003
Mailing address:
  • Phone: 254-213-7847
  • Fax: 254-312-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number64631
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: