Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 351L | AR |
Y | 101YP2500X | Professional Counselor | P1302015 | AR |
NPI | 1003192972 |
---|---|
Provider Name | Mr. Brandon L Martin I |
First Address | Harrison, AR 72601-2517 |
Second Address | Harrison, AR 72601-2517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2011 |
Last Update Date | 02/12/2020 |