Kristine Lynn Martin, MA LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CC00463 Issued in MN

Practice address

250 S 4TH St
PSC Room 510
Minneapolis, MN 55415-1335

Phone

(612) 673-2301

Fax

(612) 668-4405

NPI assigned

Mar 21, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sacred Space Psychotherapy

  • Multi-Specialty Clinic/Center
  • Bloomington, MN
  • NPI 1952232365
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337126400000",
    "number": "1366717415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1906 W 54TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554191513",
            "telephone_number": "612-824-0856",
            "fax_number": "612-668-4405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 S 4TH ST",
            "address_2": "PSC ROOM 510",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151335",
            "telephone_number": "612-673-2301",
            "fax_number": "612-668-4405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "KRISTINE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "MA LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-21",
        "last_updated": "2012-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC00463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jena Catherine Martin, M.D.
• Jody Jean Martin
• Katherine Mary Martin, CNM
• Kathy Martin, LICSW
• Kelsie Martin, AUD
• Maureen Elizabeth Martin, PHARMD
• Molly Deignan Martin, CNP
• Nijahray Martin I
• Nina Martin, MS
• Rosemary Miller Martin, MSW

• Professional Counselor in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.