Provider Demographics
NPI:1518340298
Name:MARTIN, DAVID (LPC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2082 S STONYFIELD PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-5508
Mailing Address - Country:US
Mailing Address - Phone:208-371-7226
Mailing Address - Fax:
Practice Address - Street 1:2082 S STONYFIELD PL
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-5508
Practice Address - Country:US
Practice Address - Phone:208-371-7226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC 5819101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health