Individual
RUSSELL MARTENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
4025 RAWLINS ST, CHEYENNE, WY 82001-1900
(307) 426-4797
Mailing address
1327 MARIE LN, CHEYENNE, WY 82009-3865
(303) 335-5573
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-1669
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPC-1669
WYOMING MENTAL HEALTH PROFESSIONS LICENSE
WY
Enumeration date
01/15/2016
Last updated
08/31/2020
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