1912499666 NPI number — CMARTIN THERAPY SERVICES PLLC

Table of content: (NPI 1912499666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912499666 NPI number — CMARTIN THERAPY SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CMARTIN THERAPY SERVICES PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1912499666
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
940 W FM 544 UNIT 1782
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYLIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75098-3278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-379-8379
Provider Business Mailing Address Fax Number:
214-764-3712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1723 WILDFLOWER LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYLIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75098-6688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-379-8379
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CCC-SLP, BCBA
Authorized Official Telephone Number:
972-379-8379

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-09-5783 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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