MEDICARE: MRS. ANGELA M MARTIN MA, MS, 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-2053	WY
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor	LPC-2053	WY

General Provider Information

NPI Number	:	1518629104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA M MARTIN MA, MS, LPC

Provider Business Mailing Address
First Line	:	141 S CENTER ST STE 301
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-2543
Country	:	US
Telephone Number	:	307-394-2548
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 S CENTER ST STE 301
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-2543
Country	:	US
Telephone Number	:	307-394-2548
Fax Number	:

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

Provider Enumeration Date	:	10/11/2021
Last Update Date	:	06/17/2022

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