Healthcare Provider Details

I. General information

NPI: 1326795709
Provider Name (Legal Business Name): CARLEE MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 LITTLE FLOCK DR
ROGERS AR
72756-7042
US

IV. Provider business mailing address

2113 LITTLE FLOCK DR
ROGERS AR
72756-7042
US

V. Phone/Fax

Practice location:
  • Phone: 479-621-0385
  • Fax:
Mailing address:
  • Phone: 479-621-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM2508002
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTC.0014273
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: