Healthcare Provider Details

I. General information

NPI: 1033298955
Provider Name (Legal Business Name): LORI MARTIN L.M.P., LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E MADISON ST
SEATTLE WA
98112-4871
US

IV. Provider business mailing address

2800 E MADISON ST
SEATTLE WA
98112-4871
US

V. Phone/Fax

Practice location:
  • Phone: 206-632-3593
  • Fax:
Mailing address:
  • Phone: 206-632-3593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC 60164330
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00010805
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: