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NPI Code Detail

MEDICARE: MRS. KIMBERLY L MARTIN M.ED., LPC, NCC

MEDICARE: MRS. KIMBERLY L MARTIN M.ED., LPC, NCC
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
1101YP2500XProfessional Counselor1657MS

General Provider Information

NPI Number : 1689936999
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY L MARTIN M.ED., LPC, NCC
Provider Business Mailing Address
First Line : 300 S WASHINGTON AVE
Second Line :
City : GREENVILLE
State : MS
Zip : 38701-4719
Country : US
Telephone Number : 662-725-2204
Fax Number : 662-725-2497
Provider Business Practice Location Address
First Line : 300 S WASHINGTON AVE
Second Line :
City : GREENVILLE
State : MS
Zip : 38701-4719
Country : US
Telephone Number : 662-725-2204
Fax Number : 662-725-2497
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2012
Last Update Date : 06/13/2012

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