Provider Demographics
NPI:1548432172
Name:MARTIN, JASON K (PHD, LMFT, LPC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:K
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHD, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N PENELOPE ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-2675
Mailing Address - Country:US
Mailing Address - Phone:254-300-7565
Mailing Address - Fax:254-933-3524
Practice Address - Street 1:515 N PENELOPE ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-2675
Practice Address - Country:US
Practice Address - Phone:254-300-7565
Practice Address - Fax:254-933-3524
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201058106H00000X
TX66109101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152297OtherVALUE OPTIONS