Provider Demographics
NPI:1689853574
Name:MARTIN, VICKI ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:ANN
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 1:2404 KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-8937
Mailing Address - Country:US
Mailing Address - Phone:307-221-3707
Mailing Address - Fax:307-742-6675
Practice Address - Street 1:2404 KNOLL CT
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-8937
Practice Address - Country:US
Practice Address - Phone:307-221-3707
Practice Address - Fax:307-742-6675
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY162106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist