Provider Demographics
NPI:1396782777
Name:NOLDE-MARTIN, KATHLEEN (LMHC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:NOLDE-MARTIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 N 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-3308
Mailing Address - Country:US
Mailing Address - Phone:850-696-6431
Mailing Address - Fax:
Practice Address - Street 1:1150 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-3308
Practice Address - Country:US
Practice Address - Phone:850-696-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17680101YP2500X
FLMH 9464101YM0800X
FLMH9464101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1567406Medicaid