Provider Demographics
NPI:1568930444
Name:MARTIN, LAUREN MACKENZIE (MA, TLMFT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MACKENZIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA, TLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 1ST AVE S APT 210
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-2174
Mailing Address - Country:US
Mailing Address - Phone:641-590-4665
Mailing Address - Fax:
Practice Address - Street 1:501 SW ANKENY RD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-9702
Practice Address - Country:US
Practice Address - Phone:515-289-2272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA092627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist