| Doctor Name: | MR. BRANDON L MARTIN |
| NPI Number: | 1003192972 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC, LADAC |
| License Number: | 351L |
| Business Practice Address: | 107 E Crandall Ave Harrison, AR - 726013629 |
| Business Phone Number: | 8707418484 |
| Business Fax Number: | 8707412965 |
| Mailing Address: | 2153 E Joyce Blvd Ste 201, FAYETTEVILLE |
| State: | AR |
| Postal Code: | 727035285 |
| Phone Number: | 4795759471 |
| Fax Number: | |
| NPI Enumeration Date: | 10/24/2011 |
| NPI Last Update Date: | 11/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 351L |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |