Provider Demographics
NPI:1457879629
Name:MARTIN, KAREN (MA LPC LMFT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA LPC LMFT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:HERBSTREITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8145 VALLEYWOOD LN STE B
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-5296
Mailing Address - Country:US
Mailing Address - Phone:269-234-2343
Mailing Address - Fax:
Practice Address - Street 1:8145 VALLEYWOOD LN STE B
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5296
Practice Address - Country:US
Practice Address - Phone:269-234-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011410101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health