Provider Demographics
NPI:1497012264
Name:MARTIN, CHRISTINA (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LMFT
Mailing Address - Street 1:400 S MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7801
Mailing Address - Country:US
Mailing Address - Phone:501-279-9000
Mailing Address - Fax:501-279-9011
Practice Address - Street 1:400 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7801
Practice Address - Country:US
Practice Address - Phone:501-279-9000
Practice Address - Fax:501-279-9011
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1411099101YP2500X
ARM1411010106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA1111016OtherLAMFT
ARA1111111OtherLAC