Provider Demographics
NPI:1083916209
Name:MARTIN, ROBIN LYNN (BA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:LYNN
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 679
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-0679
Mailing Address - Country:US
Mailing Address - Phone:501-354-4589
Mailing Address - Fax:
Practice Address - Street 1:818 N CREEK DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4711
Practice Address - Country:US
Practice Address - Phone:501-327-9788
Practice Address - Fax:501-327-9843
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst