Provider Demographics
NPI:1548603392
Name:MARTIN, WILLIAM M (MAPC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 7TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4966
Mailing Address - Country:US
Mailing Address - Phone:505-454-9611
Mailing Address - Fax:505-454-8079
Practice Address - Street 1:2301 7TH ST STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4966
Practice Address - Country:US
Practice Address - Phone:505-454-9611
Practice Address - Fax:505-454-8079
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0157821101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health