Provider Demographics
NPI:1831467398
Name:MARTIN, DARLENE L (CMHBCM)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CMHBCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PARK ST SE
Mailing Address - Street 2:POB 1729
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-8358
Mailing Address - Country:US
Mailing Address - Phone:580-223-7555
Mailing Address - Fax:580-226-1462
Practice Address - Street 1:500 PARK ST SE
Practice Address - Street 2:POB 1729
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-8358
Practice Address - Country:US
Practice Address - Phone:580-223-7555
Practice Address - Fax:580-226-1462
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7149103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst