Provider Demographics
NPI:1609426030
Name:MARTIN, ROBERT ARTHUR JR
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ARTHUR
Last Name:MARTIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BOBBY
Other - Middle Name:ARTHUR
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15 S GRADY WAY STE 241
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-3209
Mailing Address - Country:US
Mailing Address - Phone:425-235-9386
Mailing Address - Fax:
Practice Address - Street 1:15 S GRADY WAY STE 241
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3209
Practice Address - Country:US
Practice Address - Phone:425-235-9386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health