Provider Demographics
NPI:1922117100
Name:MARTENS, ERIN NICOLE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:NICOLE
Last Name:MARTENS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 FLYNN ST
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-2242
Mailing Address - Country:US
Mailing Address - Phone:580-327-2900
Mailing Address - Fax:580-327-1337
Practice Address - Street 1:620 FLYNN ST
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-2242
Practice Address - Country:US
Practice Address - Phone:580-327-2900
Practice Address - Fax:580-327-1337
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK4124101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor