Provider Demographics
NPI:1194018283
Name:MARTIN, CAROLYN DIANNE (LCMFT)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:DIANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 W 50TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-1719
Mailing Address - Country:US
Mailing Address - Phone:816-838-0700
Mailing Address - Fax:
Practice Address - Street 1:12351 W 96TH TER
Practice Address - Street 2:STE.300
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-4409
Practice Address - Country:US
Practice Address - Phone:913-894-0900
Practice Address - Fax:913-894-0908
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS171106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist