Provider Demographics
NPI:1437523255
Name:MARTIN, SCOTT AUSTIN (LPC INTERN)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:AUSTIN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12863 COUNTY ROAD 192
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703
Mailing Address - Country:US
Mailing Address - Phone:903-258-3166
Mailing Address - Fax:903-363-8744
Practice Address - Street 1:12863 COUNTY ROAD 192
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-6417
Practice Address - Country:US
Practice Address - Phone:903-258-3166
Practice Address - Fax:903-363-9744
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73011101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional