Provider Demographics
NPI:1801139241
Name:MARTIN, LYNN ANN (LPC)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:ANN
Other - Last Name:BEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3930 8TH ST S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-6511
Mailing Address - Country:US
Mailing Address - Phone:715-423-2030
Mailing Address - Fax:715-423-2030
Practice Address - Street 1:3930 8TH ST S
Practice Address - Street 2:SUITE 101
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-6511
Practice Address - Country:US
Practice Address - Phone:715-423-2030
Practice Address - Fax:715-423-2032
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5041-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5041-125OtherSTATE OF WI DEPT OF SAFETY & PROFESSIONAL SERVICES