Provider Demographics
NPI:1164634994
Name:MARTIN, SHAWN SITKA (MS, LCMFT)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:SITKA
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MS, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VET CENTER
Mailing Address - Street 2:251 N WATER ST
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-1292
Mailing Address - Country:US
Mailing Address - Phone:316-265-3260
Mailing Address - Fax:316-265-3623
Practice Address - Street 1:VET CENTER
Practice Address - Street 2:251 N WATER ST
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-1292
Practice Address - Country:US
Practice Address - Phone:316-265-3260
Practice Address - Fax:316-265-3623
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS231106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist