Individual
KENYON L MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
103 N 5TH ST, LEESVILLE, LA 71446-4025
(337) 238-4350
Mailing address
1000 CHINABERRY DR STE 902, BOSSIER CITY, LA 71111-2455
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
07/23/2021
Last updated
01/25/2023
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