Individual
MARY MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, NCC
Contact information
Practice address
231 N 3RD AVE, SANDPOINT, ID 83864-1423
(208) 920-3907
Mailing address
1783 BUTLER CREEK RD, COCOLALLA, ID 83813-9633
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-5894
ID
Other
Enumeration date
04/14/2016
Last updated
04/14/2016
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