Provider Demographics
NPI:1790496693
Name:MARTIN, TIMOTHY LANCE SR (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:LANCE
Last Name:MARTIN
Suffix:SR
Gender:M
Credentials:MS, LPC
Other - Prefix:MR
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:712 WALL ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6360
Mailing Address - Country:US
Mailing Address - Phone:405-579-7560
Mailing Address - Fax:
Practice Address - Street 1:712 WALL ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6360
Practice Address - Country:US
Practice Address - Phone:405-579-7560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10289101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional