Provider Demographics
NPI:1831745272
Name:MARTIN, ASANTE DEMETRIUS
Entity type:Individual
Prefix:
First Name:ASANTE
Middle Name:DEMETRIUS
Last Name:MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 BARRINGTON OAKS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2043
Mailing Address - Country:US
Mailing Address - Phone:702-596-0294
Mailing Address - Fax:
Practice Address - Street 1:1421 BARRINGTON OAKS ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-2043
Practice Address - Country:US
Practice Address - Phone:702-596-0294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1403959871106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician