| Doctor Name: | KELLY MARTIN |
| NPI Number: | 1821347394 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 65652 |
| Business Practice Address: | 19315 Fm 2252 Suite #310 Garden Ridge, TX - 782662516 |
| Business Phone Number: | 2109192911 |
| Business Fax Number: | 2107149639 |
| Mailing Address: | 19315 Fm 2252, Suite #310 GARDEN RIDGE |
| State: | TX |
| Postal Code: | 782662516 |
| Phone Number: | 2109192911 |
| Fax Number: | 2107149639 |
| NPI Enumeration Date: | 08/30/2012 |
| NPI Last Update Date: | 09/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 65652 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |