Provider Demographics
NPI:1497847610
Name:MARTIN, CHANA DAVI (BS,C-RSS)
Entity Type:Individual
Prefix:MS
First Name:CHANA
Middle Name:DAVI
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BS,C-RSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 PLEASANT DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3824
Mailing Address - Country:US
Mailing Address - Phone:405-455-1044
Mailing Address - Fax:
Practice Address - Street 1:3304 PLEASANT DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3824
Practice Address - Country:US
Practice Address - Phone:405-455-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health