Individual ProviderKatharine MartinCounselorBehavioral Health & Social Service ProvidersPractice Address1224 Centre West Dr Ste 200e, Springfield, IL 62704-2194(217) 717-4399PECOS EnrollmentBased on the most recent information from CMS, provider Katharine Martin does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1528131208Provider TypeIndividualFull NameMartin, KatharineCredentialLCPCGenderFemaleSole ProprietorYesEnumeration Date11/17/2006Last Updated12/4/2023Contact InformationPractice LocationPractice Address1224 Centre West Dr Ste 200e, Springfield, IL 62704-2194Phone(217) 717-4399Fax(217) 717-4399Mailing LocationMailing Address2930 Montvale Dr Ste E, Springfield, IL 62704-5376Phone(217) 717-4399Fax(217) 717-4399Provider TaxonomiesCodeDescriptionLicenseCode101YP2500XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicense180-004787IllinoisProvider IdentifiersIDDescriptionIssuerID669465DescriptionOtherIssuerHEALTHLINKIDMAGELLANDescriptionOtherIssuer732371000IllinoisID8432104DescriptionOtherIssuerBLUE SHIELDIllinois