Provider Demographics
NPI:1003192972
Name:MARTIN, BRANDON L I (LPC-S, LADAC)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:L
Last Name:MARTIN
Suffix:I
Gender:
Credentials:LPC-S, LADAC
Other - Prefix:
Other - First Name:BRANDON
Other - Middle Name:L
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-S,LADAC
Mailing Address - Street 1:PO BOX 1131
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602-1131
Mailing Address - Country:US
Mailing Address - Phone:870-204-6016
Mailing Address - Fax:870-782-2914
Practice Address - Street 1:716 S PINE ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-5830
Practice Address - Country:US
Practice Address - Phone:870-204-6016
Practice Address - Fax:870-782-2914
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1302015101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional