Provider Demographics
NPI:1073688941
Name:MARTIN, JAMI L (MS)
Entity Type:Individual
Prefix:MS
First Name:JAMI
Middle Name:L
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:PO BOX 11111
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47801-1111
Mailing Address - Country:US
Mailing Address - Phone:812-878-8923
Mailing Address - Fax:
Practice Address - Street 1:12991 N FREEDOM CHURCH RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62442-2922
Practice Address - Country:US
Practice Address - Phone:217-382-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor