Provider Demographics
NPI:1578738746
Name:MARTIN, KIMBERLY ANNE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:15 SW COLORADO AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1150
Mailing Address - Country:US
Mailing Address - Phone:541-647-8553
Mailing Address - Fax:541-408-9016
Practice Address - Street 1:15 SW COLORADO AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1150
Practice Address - Country:US
Practice Address - Phone:541-647-8553
Practice Address - Fax:541-408-9016
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2622101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional