Provider Demographics
NPI:1790657963
Name:MARTIN, KRISTEN JOY (QMHP-R)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JOY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:QMHP-R
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:ERICKSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2577 NE COURTNEY DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7752
Mailing Address - Country:US
Mailing Address - Phone:503-341-1224
Mailing Address - Fax:
Practice Address - Street 1:63311 JAMISON ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-8288
Practice Address - Country:US
Practice Address - Phone:541-322-7500
Practice Address - Fax:541-322-7565
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health