Provider Demographics
NPI:1508236050
Name:MARTIN MENTAL HEALTH
Entity Type:Organization
Organization Name:MARTIN MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CASEY
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:504-408-1644
Mailing Address - Street 1:7611 MAPLE ST
Mailing Address - Street 2:SUITE A-3
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5068
Mailing Address - Country:US
Mailing Address - Phone:504-408-1644
Mailing Address - Fax:
Practice Address - Street 1:7611 MAPLE ST
Practice Address - Street 2:SUITE A-3
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5068
Practice Address - Country:US
Practice Address - Phone:504-408-1644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-27
Last Update Date:2015-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1942626064OtherINDIVIDUAL NPI