Provider Demographics
NPI:1770993859
Name:MARTIN, KRISTEN AUBERRY (MA/MS)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:AUBERRY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA/MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 EUCLID AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-6429
Mailing Address - Country:US
Mailing Address - Phone:859-705-8075
Mailing Address - Fax:
Practice Address - Street 1:620 EUCLID AVE STE 203
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-6429
Practice Address - Country:US
Practice Address - Phone:859-705-8075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2014-002106H00000X
KY169250106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid