Provider Demographics
NPI:1558597401
Name:MARTIN, LESTER WYLIE (LPC)
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:WYLIE
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:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75483-0146
Mailing Address - Country:US
Mailing Address - Phone:903-885-2776
Mailing Address - Fax:903-885-3613
Practice Address - Street 1:2121 MAIN ST
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-3616
Practice Address - Country:US
Practice Address - Phone:903-885-2776
Practice Address - Fax:903-885-3613
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62999101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional