Provider Demographics
NPI:1255467353
Name:MARTIN, MARLON (LCDC)
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13217 BARON HILL LN
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-2178
Mailing Address - Country:US
Mailing Address - Phone:281-652-5821
Mailing Address - Fax:281-994-9189
Practice Address - Street 1:11200 BROADWAY ST STE 2743
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-9787
Practice Address - Country:US
Practice Address - Phone:281-652-5821
Practice Address - Fax:281-994-9189
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89596261QM0801X, 261QM0850X, 261QM0855X
TX10302261QR0405X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder