Provider Demographics
NPI:1881579076
Name:MARTIN, MINDY S (LMHCA)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:S
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 87852
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98687-7852
Mailing Address - Country:US
Mailing Address - Phone:801-792-6858
Mailing Address - Fax:
Practice Address - Street 1:16701 SE MCGILLIVRAY BLVD STE 125
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4307
Practice Address - Country:US
Practice Address - Phone:360-555-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC.61672841101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health