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General NPI Number Information
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NPI Number | 1700273976
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Entity Type | Organization
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Legal Business Name | MICHELE MARTIN AND ASSOCIATES
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Dates
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Enumeration Date | 04/24/2015
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Last Update Date | 04/24/2015
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Provider Practice Location Address
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Address Line | 30 N MICHIGAN AVE SUITE 819
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City | CHICAGO
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State | IL
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Zip | 60602-3402
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Country | US
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Telephone | 847-624-2776
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Fax |
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Provider Business Mailing Address
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Address Line | 537 SHERIDAN RD APT. 2 SOUTH
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City | EVANSTON
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State | IL
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Zip | 60202-3193
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Country | US
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Telephone | 847-624-2776
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MICHELE MARION MARTIN
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Credential | LMFT, PHD
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Telephone | 847-624-2776
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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 | 166000697
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License Number State | IL
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