Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 8767 | TX |
NPI | 1003098187 |
---|---|
Provider Name | Robert Keith Martin |
First Address | Corpus Christi, TX 78404 |
Second Address | Corpus Christi, TX 78404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2007 |
Last Update Date | 30/11/2007 |