Provider Demographics
NPI:1700210192
Name:MARTIN CENTER FOR ABA AND BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:MARTIN CENTER FOR ABA AND BEHAVIORAL SERVICES, LLC
Other - Org Name:MARTIN CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC. DIR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:615-613-1869
Mailing Address - Street 1:1853 MADISON STREET
Mailing Address - Street 2:UNIT 8
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043
Mailing Address - Country:US
Mailing Address - Phone:615-613-1869
Mailing Address - Fax:931-919-2191
Practice Address - Street 1:270 CLEAR SKY COURT
Practice Address - Street 2:SUITE C
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:615-613-1869
Practice Address - Fax:931-919-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-11-9471103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty