Individual
MRS. KATELYN ELIZABETH MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA, LBA
Contact information
Practice address
4061 SUZANNE DR, DIBERVILLE, MS 39540
(228) 396-4434
(228) 396-4438
Mailing address
3173B CANARY CIR, GULFPORT, MS 39501-4508
(228) 731-9598
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
180058
MS
Other
Enumeration date
10/14/2015
Last updated
07/30/2018
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