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General NPI Number Information
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NPI Number | 1003855743
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Entity Type | Individual
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Provider Name | LELAND KARL MARTIN PHD
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 07/07/2022
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Provider Practice Location Address
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Address Line | 2434 COMMERCE BLVD STE A
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City | MOUND
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State | MN
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Zip | 55364-1480
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Country | US
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Telephone | 952-595-0562
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Fax | 952-595-0564
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Provider Business Mailing Address
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Address Line | 2434 COMMERCE BLVD STE A
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City | MOUND
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State | MN
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Zip | 55364-1480
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Country | US
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Telephone | 952-595-0562
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Fax | 952-595-0564
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP3095
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License Number State | MN
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