Provider Demographics
NPI:1093321986
Name:MARTIN, BRET SAMUEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRET
Middle Name:SAMUEL
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 HARVESTMEADE ST APT 1317
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76155-2813
Mailing Address - Country:US
Mailing Address - Phone:214-801-2823
Mailing Address - Fax:
Practice Address - Street 1:1221 ABRAMS RD STE 325
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5579
Practice Address - Country:US
Practice Address - Phone:469-619-7622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist