Provider Demographics
NPI:1114313749
Name:MARTIN, KELLY M (LIMHP, LADC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LIMHP, LADC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:M
Other - Last Name:HANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4316 S 48TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-1287
Mailing Address - Country:US
Mailing Address - Phone:402-264-6716
Mailing Address - Fax:
Practice Address - Street 1:4316 S 48TH ST STE 2
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-1287
Practice Address - Country:US
Practice Address - Phone:402-264-6716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1420101YA0400X
NE2971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)