Provider Demographics
NPI:1023035953
Name:GAY, MARTIN JAMES (MS, LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:JAMES
Last Name:GAY
Suffix:
Gender:M
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 CANNON ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2589
Mailing Address - Country:US
Mailing Address - Phone:503-375-6362
Mailing Address - Fax:503-581-6046
Practice Address - Street 1:1335 CANNON ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2589
Practice Address - Country:US
Practice Address - Phone:503-375-6362
Practice Address - Fax:503-581-6046
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1190101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional