Provider Demographics
NPI:1265634943
Name:MARTIN, CATHERINE JANE (MA LPC ACS)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:JANE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA LPC ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2034 E HELEN ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-4702
Mailing Address - Country:US
Mailing Address - Phone:520-237-5163
Mailing Address - Fax:
Practice Address - Street 1:2034 E HELEN ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-4702
Practice Address - Country:US
Practice Address - Phone:520-237-5163
Practice Address - Fax:520-203-7431
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12269101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional