Provider Demographics
NPI:1891246419
Name:MARTIN, DAVID M (LPCC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TODA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529-7101
Mailing Address - Country:US
Mailing Address - Phone:575-779-2045
Mailing Address - Fax:
Practice Address - Street 1:11 TODA VISTA RD
Practice Address - Street 2:
Practice Address - City:EL PRADO
Practice Address - State:NM
Practice Address - Zip Code:87529-7101
Practice Address - Country:US
Practice Address - Phone:575-779-2045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator