Provider Demographics
NPI:1861016990
Name:MARTIN, LANI DANELLE (MS)
Entity type:Individual
Prefix:MRS
First Name:LANI
Middle Name:DANELLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 SW SEDGWICK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-6433
Mailing Address - Country:US
Mailing Address - Phone:564-669-5250
Mailing Address - Fax:564-669-5255
Practice Address - Street 1:435 SW SEDGWICK RD STE 101
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-6433
Practice Address - Country:US
Practice Address - Phone:564-669-5250
Practice Address - Fax:645-669-5255
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 390200000X
WA61537422101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program