Active NPI
Kristin M Martin
- Counselor
- Colville, WA
National Provider Identifier
1851893903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- CG61479158
- Practice address
- 165 E Hawthorne Ave
Colville, WA 99114-2629 - Phone
- (509) 684-4597
- NPI assigned
- Mar 5, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-15-07321 | TN | |
| Counselor | 101Y00000X | CG61479158 | WA | Primary |
Addresses
Primary practice location
165 E Hawthorne Ave
Colville, WA 99114-2629
Mailing address
165 E Hawthorne Ave
Colville, WA 99114-2629
Phone (509) 684-4597
Other practice location 1
3441 Fort Campbell Blvd Ste F3
Clarksville, TN 37042-6684
Phone (931) 449-0063
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RBT-15-07321 | Other | TN | BACB |
Other names 1
- Kristin Gagnon
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG61479158 | WA | MD | Counselor |
| RBT-15-07321 | TN | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Behavior Consultants | Behavior Technician | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692662400000",
"number": "1851893903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "165 E HAWTHORNE AVE",
"city": "COLVILLE",
"state": "WA",
"postal_code": "991142629",
"telephone_number": "509-684-4597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "165 E HAWTHORNE AVE",
"city": "COLVILLE",
"state": "WA",
"postal_code": "991142629",
"telephone_number": "509-684-4597"
}
],
"practiceLocations": [
{
"address_1": "3441 Fort Campbell Blvd Ste F3",
"address_purpose": "LOCATION",
"city": "Clarksville",
"state": "TN",
"postal_code": "370426684",
"country_code": "US",
"telephone_number": "931-449-0063",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MARTIN",
"first_name": "KRISTIN",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-05",
"last_updated": "2023-08-22",
"certification_date": "2023-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "TN",
"license": "RBT-15-07321",
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": "CG61479158",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BACB",
"identifier": "RBT-15-07321",
"state": "TN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KRISTIN",
"last_name": "GAGNON",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Colville, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.