Individual
KELLI MICHELLE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
245 FOUNTAIN CT, LEXINGTON, KY 40509-2792
(859) 323-6021
(859) 323-1670
Mailing address
205 CHAMPION WAY STE 11, GEORGETOWN, KY 40324-8862
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
255153
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790731081
—
KY
Enumeration date
12/05/2017
Last updated
09/22/2023
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