Provider Demographics
NPI:1710010400
Name:MARTIN, ROD (LCMFT)
Entity Type:Individual
Prefix:MR
First Name:ROD
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SW RIVER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:KS
Mailing Address - Zip Code:67144-9361
Mailing Address - Country:US
Mailing Address - Phone:316-320-9333
Mailing Address - Fax:316-541-2697
Practice Address - Street 1:120 N MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2058
Practice Address - Country:US
Practice Address - Phone:316-320-9333
Practice Address - Fax:316-541-2697
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS072106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist