MEDICARE: MRS. LAURA MARIE MARTIN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC.0015452	CO

General Provider Information

NPI Number	:	1033737952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA MARIE MARTIN LPC

Provider Business Mailing Address
First Line	:	6805 CORPORATE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-1976
Country	:	US
Telephone Number	:	719-428-1129
Fax Number	:	719-631-0699

Provider Business Practice Location Address
First Line	:	6805 CORPORATE DR STE 120
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-1977
Country	:	US
Telephone Number	:	719-726-8811
Fax Number	:	719-631-0699

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	02/25/2025

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