Provider Demographics
NPI:1386193209
Name:SKRIVANOS, MARTIN (LPC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:SKRIVANOS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5507 RANCH DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4538
Mailing Address - Country:US
Mailing Address - Phone:501-291-3732
Mailing Address - Fax:501-251-1091
Practice Address - Street 1:5507 RANCH DR
Practice Address - Street 2:SUITE 207
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4538
Practice Address - Country:US
Practice Address - Phone:501-291-3732
Practice Address - Fax:501-251-1091
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1609147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health