Provider Demographics
NPI:1588099501
Name:MARTIN, JANET CHRISTINE (LPCC)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:CHRISTINE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 PAYNE AVE.
Mailing Address - Street 2:ABC MENTAL HEALTH THERAPY
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-3842
Mailing Address - Country:US
Mailing Address - Phone:651-644-2600
Mailing Address - Fax:651-644-2888
Practice Address - Street 1:1077 PAYNE AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-3842
Practice Address - Country:US
Practice Address - Phone:651-644-2600
Practice Address - Fax:651-644-2888
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN646101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional