Individual
CARISSA MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY D
Contact information
Practice address
600 E 5TH ST, FULTON, MO 65251-1753
(573) 592-3355
Mailing address
2309 W BROADWAY APT 113, COLUMBIA, MO 65203-1274
(502) 472-4499
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2020004458
MO
Other
Enumeration date
08/18/2015
Last updated
12/16/2020
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