Healthcare Provider Details

I. General information

NPI: 1689456873
Provider Name (Legal Business Name): KINLEY MARIE MARTIN AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 E 1200 S # 201
OREM UT
84058-6904
US

IV. Provider business mailing address

363 E 1200 S # 201
OREM UT
84058-6904
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-2313
  • Fax:
Mailing address:
  • Phone: 801-224-2313
  • Fax: 801-224-4475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: