Provider Demographics
NPI:1093694671
Name:MARTIN, MATITA (LMHC)
Entity type:Individual
Prefix:
First Name:MATITA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4371 LYNX PAW TRL
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7426
Mailing Address - Country:US
Mailing Address - Phone:813-657-2100
Mailing Address - Fax:813-354-2422
Practice Address - Street 1:4371 LYNX PAW TRL
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-7426
Practice Address - Country:US
Practice Address - Phone:813-657-2100
Practice Address - Fax:813-354-2422
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health