Provider Demographics
NPI:1376900654
Name:MARTIN, KELLY ANN (MS, LPC, LCDC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS, LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8005 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-4021
Mailing Address - Country:US
Mailing Address - Phone:469-450-8719
Mailing Address - Fax:
Practice Address - Street 1:8005 GREENWOOD DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-4021
Practice Address - Country:US
Practice Address - Phone:469-450-8719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-18
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70902101Y00000X, 101YP2500X
TXLCDC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)