Provider Demographics
NPI:1003098187
Name:MARTIN, ROBERT KEITH (BA LCDC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KEITH
Last Name:MARTIN
Suffix:
Gender:M
Credentials:BA LCDC
Other - Prefix:
Other - First Name:BOBBY
Other - Middle Name:KEITH
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1801 S ALAMEDA
Mailing Address - Street 2:STE 150
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404
Mailing Address - Country:US
Mailing Address - Phone:361-854-9199
Mailing Address - Fax:361-888-9250
Practice Address - Street 1:1801 S ALAMEDA
Practice Address - Street 2:STE 150
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404
Practice Address - Country:US
Practice Address - Phone:361-854-9199
Practice Address - Fax:361-888-9250
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8767101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)