1790941557 NPI number — MR. CHARLES ROBERT MARTIN LMFT LMHC NCC

Table of content: MR. CHARLES ROBERT MARTIN LMFT LMHC NCC (NPI 1790941557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790941557 NPI number — MR. CHARLES ROBERT MARTIN LMFT LMHC NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
CHARLES
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMFT LMHC NCC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790941557
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
613 CHERRY ST
Provider Second Line Business Mailing Address:
ST MARYS MINISTRY CENTER
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47713-1807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-425-1577
Provider Business Mailing Address Fax Number:
812-426-1416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
613 CHERRY ST
Provider Second Line Business Practice Location Address:
ST MARYS MINISTRY CENTER
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47713-1807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-425-1577
Provider Business Practice Location Address Fax Number:
812-426-1416
Provider Enumeration Date:
07/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  39000879A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 35000349A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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