Provider Demographics
NPI:1326387317
Name:ST. MARTIN, MARK (PHD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ST. MARTIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 W. MICHIGAN AVE.
Mailing Address - Street 2:CENTER FOR COUNSELING AND PSYCHOLOGICAL SERVICES
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-5226
Mailing Address - Country:US
Mailing Address - Phone:269-387-5105
Mailing Address - Fax:
Practice Address - Street 1:1903 W. MICHIGAN AVE.
Practice Address - Street 2:CENTER FOR COUNSELING AND PSYCHOLOGICAL SERVICES
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-5226
Practice Address - Country:US
Practice Address - Phone:269-387-5105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009274101YP2500X
MI6301013841103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional