Provider Demographics
NPI:1689983611
Name:MARTIN, KATRINA S (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:S
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 E GRAND AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4380
Mailing Address - Country:US
Mailing Address - Phone:307-399-7437
Mailing Address - Fax:
Practice Address - Street 1:2020 E GRAND AVE STE 410
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4380
Practice Address - Country:US
Practice Address - Phone:307-399-7437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1271101YP2500X
WY538101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor