Healthcare Provider Details

I. General information

NPI: 1356984710
Provider Name (Legal Business Name): JAMES DANIEL MARTIN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 WYNN CT
THOUSAND OAKS CA
91362-3143
US

IV. Provider business mailing address

368 WYNN CT
THOUSAND OAKS CA
91362-3143
US

V. Phone/Fax

Practice location:
  • Phone: 310-988-9613
  • Fax:
Mailing address:
  • Phone: 310-988-9613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number146969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: