Provider Demographics
NPI:1699049528
Name:MARTIN, KRISTINE ELIZABETH (LPC)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:ELIZABETH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 W 9TH ST N
Mailing Address - Street 2:SUITE B
Mailing Address - City:LADYSMITH
Mailing Address - State:WI
Mailing Address - Zip Code:54848-1267
Mailing Address - Country:US
Mailing Address - Phone:715-532-9771
Mailing Address - Fax:715-532-9774
Practice Address - Street 1:804 W 9TH ST N
Practice Address - Street 2:SUITE B
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-1267
Practice Address - Country:US
Practice Address - Phone:715-532-9771
Practice Address - Fax:715-532-9774
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI406-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health