Provider Demographics
NPI:1457399651
Name:MARTIN, ROBERT WESLEY (LPC-LMFT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WESLEY
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LPC-LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25145 GRANITE HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:CUSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57730-2501
Mailing Address - Country:US
Mailing Address - Phone:605-673-4330
Mailing Address - Fax:
Practice Address - Street 1:25145 GRANITE HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:CUSTER
Practice Address - State:SD
Practice Address - Zip Code:57730-2501
Practice Address - Country:US
Practice Address - Phone:605-673-4330
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLMFT1179101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health