Provider Demographics
NPI:1629284278
Name:MARTIN, PATRICIA LYNN (LMFT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-2654
Mailing Address - Country:US
Mailing Address - Phone:574-533-0926
Mailing Address - Fax:
Practice Address - Street 1:63846 COUNTY ROAD 35
Practice Address - Street 2:SUITE 2
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-9621
Practice Address - Country:US
Practice Address - Phone:574-523-1839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001575A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist