Provider Demographics
NPI:1679364095
Name:MARTIN, SAVANNAH LORAINE
Entity type:Individual
Prefix:MRS
First Name:SAVANNAH
Middle Name:LORAINE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:LORAINE
Other - Last Name:CRABTREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6230 LAPIS LN
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5425
Mailing Address - Country:US
Mailing Address - Phone:850-400-6098
Mailing Address - Fax:866-265-8817
Practice Address - Street 1:1001 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-6943
Practice Address - Country:US
Practice Address - Phone:850-400-6098
Practice Address - Fax:866-265-8817
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-436224106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician