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General NPI Number Information
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NPI Number | 1609201615
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Entity Type | Individual
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Provider Name | DR. CARMEN KNUDSON-MARTIN
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Gender | Female
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Dates
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Enumeration Date | 09/10/2013
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 21121 NE SHORE DR
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City | FAIRVIEW
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State | OR
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Zip | 97024-6762
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Country | US
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Telephone | 909-262-7725
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Fax |
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Provider Business Mailing Address
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Address Line | 21121 NE SHORE DR
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City | FAIRVIEW
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State | OR
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Zip | 97024-6762
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Country | US
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Telephone | 909-262-7725
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | T0736
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 40993
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT000876
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License Number State | GA
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