| Audrey L. Martin Llc | |
|
304 N Church St Hazelton KS 67061-9300 | |
| (620) 239-4031 | |
| Not Available |
| Full Name | Audrey L. Martin Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 304 N Church St, Hazelton, Kansas |
| Authorized Official Name and Position | Audrey Martin (OWNER) |
| Authorized Official Contact | 3166442944 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Audrey L. Martin Llc 416 N Oak St Medicine Lodge KS 67104-1274 Ph: (316) 644-2944 | Audrey L. Martin Llc 304 N Church St Hazelton KS 67061-9300 Ph: (620) 239-4031 |
| NPI Number | 1750973053 |
|---|---|
| Provider Enumeration Date | 02/08/2021 |
| Last Update Date | 02/08/2021 |
| Certification Date | 02/08/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750973053 | NPI | - | NPPES |
| 200656430B | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
Freedom Gates Boys Ranch Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 304 N Church St, Hazelton, KS 67061 Phone: 620-239-4031 Fax: 620-239-4032 |