| Doctor Name: | LISA MARIE MARTIN |
| NPI Number: | 1619013521 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LLP |
| License Number: | 6301007850 |
| Business Practice Address: | 112 E Chart St Plainwell, MI - 490801768 |
| Business Phone Number: | 2696856363 |
| Business Fax Number: | 2696855995 |
| Mailing Address: | 8433 N 12th St, KALAMAZOO |
| State: | MI |
| Postal Code: | 490099017 |
| Phone Number: | 2693816351 |
| Fax Number: | |
| NPI Enumeration Date: | 01/29/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 6301007850 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |