Provider Demographics
NPI:1689094211
Name:MARTIN, TAMMI (LPC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:TAMMI
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-8346
Mailing Address - Country:US
Mailing Address - Phone:405-651-6338
Mailing Address - Fax:
Practice Address - Street 1:3915 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7586
Practice Address - Country:US
Practice Address - Phone:405-524-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional