Provider Demographics
NPI:1700150638
Name:MARTENSON, NINA KAY (TLLP)
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:KAY
Last Name:MARTENSON
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1353
Mailing Address - Country:US
Mailing Address - Phone:616-550-9343
Mailing Address - Fax:
Practice Address - Street 1:6250 M 66 N
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-9272
Practice Address - Country:US
Practice Address - Phone:231-547-5885
Practice Address - Fax:231-547-0136
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014417103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist