Healthcare Provider Details

I. General information

NPI: 1780876938
Provider Name (Legal Business Name): KATHYRN LEE MARTIN LMHC & SUDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/22/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7507 NE 51ST ST
VANCOUVER WA
98662-6007
US

IV. Provider business mailing address

7505 NE 51ST STREET
VANCOUVER WA
98662-1824
US

V. Phone/Fax

Practice location:
  • Phone: 360-710-3710
  • Fax:
Mailing address:
  • Phone: 360-710-3610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00001816
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00004237
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: