Provider Demographics
NPI:1326048505
Name:MARTIN, LOUISA H (MED)
Entity Type:Individual
Prefix:MRS
First Name:LOUISA
Middle Name:H
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 MICCOSUKEE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5322
Mailing Address - Country:US
Mailing Address - Phone:850-556-5934
Mailing Address - Fax:850-877-7733
Practice Address - Street 1:1908 MICCOSUKEE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5322
Practice Address - Country:US
Practice Address - Phone:850-556-5934
Practice Address - Fax:850-877-7733
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT0001295106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5025OtherBLUE CROSS/BLUE SHIELD