Individual
LISA MARIE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LLP
Contact information
Practice address
112 E CHART ST, PLAINWELL, MI 49080-1768
(269) 685-6363
(269) 685-5995
Mailing address
8433 N 12TH ST, KALAMAZOO, MI 49009-9017
(269) 381-6351
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
6301007850
MI
103T00000X
Psychologist
Primary
6301007850
MI
103TC1900X
Counseling Psychologist
6302007850
MI
Other
Enumeration date
01/29/2007
Last updated
01/14/2020
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