Provider Demographics
NPI:1629124680
Name:MARTIN, PEGGY GENE (MASTERS OF ARTS IN P)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:GENE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MASTERS OF ARTS IN P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 S WILLIS
Mailing Address - Street 2:STE 1221
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605
Mailing Address - Country:US
Mailing Address - Phone:325-692-8810
Mailing Address - Fax:
Practice Address - Street 1:1290 S WILLIS
Practice Address - Street 2:STE 1221
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605
Practice Address - Country:US
Practice Address - Phone:325-692-8810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11016101YP2500X, 103T00000X
TX000618000612106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist