Provider Demographics
NPI:1467508671
Name:MARTIN, BILL CRAIG (MFT)
Entity Type:Individual
Prefix:MR
First Name:BILL
Middle Name:CRAIG
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91944-0519
Mailing Address - Country:US
Mailing Address - Phone:619-686-9302
Mailing Address - Fax:858-755-9010
Practice Address - Street 1:1337 CAMINO DEL MAR
Practice Address - Street 2:STE. E
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2504
Practice Address - Country:US
Practice Address - Phone:858-755-2407
Practice Address - Fax:858-755-9010
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33939106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist