Provider Demographics
NPI:1215493010
Name:MARTIN, CLAIRE (LPC, NCC)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 S BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1829
Mailing Address - Country:US
Mailing Address - Phone:347-860-3351
Mailing Address - Fax:
Practice Address - Street 1:2100 S BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-1829
Practice Address - Country:US
Practice Address - Phone:347-860-3351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-16
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017017269101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty