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General NPI Number Information
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NPI Number | 1013146349
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Entity Type | Individual
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Provider Name | JENNIFER MARTIN LCPC
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Gender | Female
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Dates
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Enumeration Date | 07/08/2009
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 812 SKYLINE DR STE 200
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City | MARION
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State | IL
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Zip | 62959-4874
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Country | US
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Telephone | 618-440-1534
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Fax |
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Provider Business Mailing Address
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Address Line | 205 N FOZZARD ST
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City | MARION
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State | IL
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Zip | 62959-1131
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Country | US
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Telephone | 618-542-5779
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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