Provider Demographics
NPI:1295276822
Name:MARTIN, TAMMY A (LPC)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 CUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-3230
Mailing Address - Country:US
Mailing Address - Phone:432-559-3539
Mailing Address - Fax:
Practice Address - Street 1:1404 N GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761
Practice Address - Country:US
Practice Address - Phone:432-692-4777
Practice Address - Fax:432-272-0852
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73518101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional