Provider Demographics
NPI:1043387657
Name:MARTIN, ALLISON BRELAND (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:BRELAND
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 ROSS RD
Mailing Address - Street 2:P. O. BOX 788
Mailing Address - City:ANACOCO
Mailing Address - State:LA
Mailing Address - Zip Code:71403-3316
Mailing Address - Country:US
Mailing Address - Phone:318-623-2287
Mailing Address - Fax:
Practice Address - Street 1:620 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4429
Practice Address - Country:US
Practice Address - Phone:318-623-2287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1039106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist