Provider Demographics
NPI:1922445121
Name:MARTIN, THOMAS ARNOLD (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ARNOLD
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 E HARTLEY AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-7632
Mailing Address - Country:US
Mailing Address - Phone:760-375-3364
Mailing Address - Fax:
Practice Address - Street 1:501 ATKINS ST
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-2501
Practice Address - Country:US
Practice Address - Phone:760-371-5928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 20943106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist