Provider Demographics
NPI:1477515534
Name:DESCHNER, MARTIN JOHN (PHD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:JOHN
Last Name:DESCHNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 INTERSTATE 30
Mailing Address - Street 2:SUITE B-240
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2696
Mailing Address - Country:US
Mailing Address - Phone:972-681-7246
Mailing Address - Fax:972-681-1079
Practice Address - Street 1:3500 INTERSTATE 30
Practice Address - Street 2:SUITE B-240
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2696
Practice Address - Country:US
Practice Address - Phone:972-681-7246
Practice Address - Fax:972-681-1079
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24108103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87438AOtherBCBS
TX040228101Medicaid