Provider Demographics
NPI:1003192972
Name:MARTIN, BRANDON L I (LPC, LADAC)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:L
Last Name:MARTIN
Suffix:I
Gender:M
Credentials:LPC, LADAC
Other - Prefix:
Other - First Name:BRANDON
Other - Middle Name:L
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC,LADAC
Mailing Address - Street 1:1003 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2517
Mailing Address - Country:US
Mailing Address - Phone:870-704-9711
Mailing Address - Fax:
Practice Address - Street 1:1003 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2517
Practice Address - Country:US
Practice Address - Phone:870-204-6016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR351L101YA0400X
ARP1302015101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)