Provider Demographics
NPI:1740426832
Name:MARTIN, LORI COX (MED)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:COX
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E REYNOLDS ST STE 606
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-3370
Mailing Address - Country:US
Mailing Address - Phone:813-707-9661
Mailing Address - Fax:813-764-9363
Practice Address - Street 1:110 E REYNOLDS ST STE 606
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-3370
Practice Address - Country:US
Practice Address - Phone:813-707-9661
Practice Address - Fax:813-764-9363
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS#0000554101Y00000X, 103T00000X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist