Provider Demographics
NPI:1376364042
Name:MARTIN MINDS LLC
Entity type:Organization
Organization Name:MARTIN MINDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:II
Authorized Official - Credentials:LPC
Authorized Official - Phone:856-912-0225
Mailing Address - Street 1:147 TUCKERTON RD
Mailing Address - Street 2:
Mailing Address - City:SHAMONG
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-8663
Mailing Address - Country:US
Mailing Address - Phone:856-912-0225
Mailing Address - Fax:
Practice Address - Street 1:147 TUCKERTON RD
Practice Address - Street 2:
Practice Address - City:SHAMONG
Practice Address - State:NJ
Practice Address - Zip Code:08088-8663
Practice Address - Country:US
Practice Address - Phone:856-912-0225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty