Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 725 | KY |
NPI | 1053411777 |
---|---|
Provider Name | Dr. Martin Lindley Seitz |
First Address | Wilmore, KY 40390-1014 |
Second Address | Lexington, KY 40503-2914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2006 |
Last Update Date | 15/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11639140 | CAQH (01) | KY |