Individual
MS. PAULA SHANE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS,LSW,LMHC
Contact information
Practice address
909 E STATE BLVD, FORT WAYNE, IN 46807-3513
(260) 481-2700
Mailing address
909 E STATE BLVD, FORT WAYNE, IN 46805-3404
(260) 481-2700
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39001302A
IN
Other
Enumeration date
05/22/2007
Last updated
11/23/2009
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