Individual
CODY MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
108 W MARKET ST, BLOOMINGTON, IL 61701-3918
(309) 827-5351
Mailing address
108 W MARKET ST, BLOOMINGTON, IL 61701-3918
(309) 827-5351
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
12/09/2015
Last updated
12/09/2015
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