Provider Demographics
NPI:1508977794
Name:LUMPKIN, MARTIN ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ALAN
Last Name:LUMPKIN
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 1:401 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-2055
Mailing Address - Country:US
Mailing Address - Phone:972-563-1831
Mailing Address - Fax:
Practice Address - Street 1:102 E MOORE AVE
Practice Address - Street 2:235
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-3204
Practice Address - Country:US
Practice Address - Phone:972-563-1831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20897103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000H74R6Medicaid
TX00H74ROtherBLUE CROSS
TX92850403OtherUNITED BEHAVIORAL HEALTH
TXU08150125OtherCIGNA
TX4485497OtherAETNA
TXP000H74R6Medicaid
TXR58214Medicare UPIN