Provider Demographics
NPI:1316375793
Name:MARTIN, SHERYL (LPA)
Entity Type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 DENALI ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2746
Mailing Address - Country:US
Mailing Address - Phone:907-272-4407
Mailing Address - Fax:907-272-4463
Practice Address - Street 1:2600 DENALI ST
Practice Address - Street 2:SUITE 302
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2746
Practice Address - Country:US
Practice Address - Phone:907-272-4407
Practice Address - Fax:907-272-4463
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10AA89101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health