Provider Demographics
NPI:1598017337
Name:LOUKOTKA, MARTHA KRISTIN (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:KRISTIN
Last Name:LOUKOTKA
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 GUYTON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4345
Mailing Address - Country:US
Mailing Address - Phone:205-266-4460
Mailing Address - Fax:
Practice Address - Street 1:3602 GUYTON RIDGE DR
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4345
Practice Address - Country:US
Practice Address - Phone:205-266-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1031349103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1031349OtherBCBA