Provider Demographics
NPI:1952450538
Name:MARTIN, CAROLYN R (MS,LMLP,LCP,AAPS,RAO)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS,LMLP,LCP,AAPS,RAO
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:R
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,LMLP,AAPS,RAODAC
Mailing Address - Street 1:1000 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2449
Mailing Address - Country:US
Mailing Address - Phone:620-343-2211
Mailing Address - Fax:620-342-1021
Practice Address - Street 1:1000 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2449
Practice Address - Country:US
Practice Address - Phone:620-343-2211
Practice Address - Fax:620-342-1021
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0063103TC0700X
KS082103TC0700X
KS0355103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical