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General NPI Number Information
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NPI Number | 1710546973
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Entity Type | Individual
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Provider Name | KRISTEN MARTIN LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 8125 S WALKER AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73139-9417
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Country | US
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Telephone | 405-835-3285
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Fax |
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Provider Business Mailing Address
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Address Line | 4617 W NICKLAS AVE APT C
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City | OKLAHOMA CITY
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State | OK
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Zip | 73132-6919
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Country | US
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Telephone | 903-280-3911
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9506-M
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 20533
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License Number State | OK
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