Provider Demographics
NPI:1831312669
Name:MARTIN, FRANK WILSON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:WILSON
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 E 15TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5712
Mailing Address - Country:US
Mailing Address - Phone:214-769-6114
Mailing Address - Fax:
Practice Address - Street 1:704 E 15TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5712
Practice Address - Country:US
Practice Address - Phone:214-769-6114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX551121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX55112OtherLICENSED CLINICAL SOCIAL WORKER