Provider Demographics
NPI:1407621113
Name:MARTIN, KATHERINE MEGAN (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MEGAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 W STAN SCHLUETER LOOP STE 100
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-6691
Mailing Address - Country:US
Mailing Address - Phone:254-213-7847
Mailing Address - Fax:254-312-2003
Practice Address - Street 1:1103 W STAN SCHLUETER LOOP STE 100
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-6691
Practice Address - Country:US
Practice Address - Phone:254-213-7847
Practice Address - Fax:254-312-2003
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX646311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical