Provider Demographics
NPI:1366692675
Name:MARTIN, CONNIE MAY (BS, BA)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:MAY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BS, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4809
Mailing Address - Country:US
Mailing Address - Phone:580-399-0200
Mailing Address - Fax:
Practice Address - Street 1:620 E COURT ST
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-3016
Practice Address - Country:US
Practice Address - Phone:580-364-0170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator