Provider Demographics
NPI:1386619146
Name:MARTIN, PATRICIA COLLINS (RN MAMFT)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:COLLINS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN MAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 PARK PLAZA AVENUE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241
Mailing Address - Country:US
Mailing Address - Phone:502-327-0209
Mailing Address - Fax:502-426-4902
Practice Address - Street 1:9700 PARK PLAZA AVENUE
Practice Address - Street 2:SUITE 105
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241
Practice Address - Country:US
Practice Address - Phone:502-327-0209
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0530106H00000X
KY1051501163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1051501OtherKY BOARD OF NURSING
KYKY0530OtherBD OF MARRIAGE,FAM THER.