Provider Demographics
NPI:1104033646
Name:MARTIN, ELIZABETH STANDIFORD SANDERS (LPCC, ATR)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:STANDIFORD SANDERS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPCC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MCCREADY AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2750
Mailing Address - Country:US
Mailing Address - Phone:502-558-1025
Mailing Address - Fax:502-629-8827
Practice Address - Street 1:208 MCCREADY AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2750
Practice Address - Country:US
Practice Address - Phone:502-558-1025
Practice Address - Fax:502-629-8827
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0896101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional