Doctor Name: | MR. ROBERT WESLEY MARTIN |
NPI Number: | 1457399651 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC-LMFT |
License Number: | LMFT1179 |
Business Practice Address: | 25145 Granite Heights Dr Custer, SD - 577302501 |
Business Phone Number: | 6056734330 |
Business Fax Number: | |
Mailing Address: | 25145 Granite Heights Dr, CUSTER |
State: | SD |
Postal Code: | 577302501 |
Phone Number: | 6056734330 |
Fax Number: | |
NPI Enumeration Date: | 06/02/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LMFT1179 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |