Provider Demographics
NPI:1851438998
Name:BIRCH, MARTHA KAY (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:KAY
Last Name:BIRCH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2749 CANNAN RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-2782
Mailing Address - Country:US
Mailing Address - Phone:217-454-3050
Mailing Address - Fax:
Practice Address - Street 1:247 W PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62523-1220
Practice Address - Country:US
Practice Address - Phone:217-428-3458
Practice Address - Fax:217-935-4508
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003266101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)