Provider Demographics
NPI:1023453016
Name:MARTIN, SANDRA KAY (LMFT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:KAY
Other - Last Name:SAMPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:7400 METRO BLVD
Mailing Address - Street 2:SUITE 412
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439
Mailing Address - Country:US
Mailing Address - Phone:612-267-2885
Mailing Address - Fax:612-429-5721
Practice Address - Street 1:7400 METRO BLVD
Practice Address - Street 2:SUITE 412
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439
Practice Address - Country:US
Practice Address - Phone:612-267-2885
Practice Address - Fax:612-429-5721
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2346106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist