Healthcare Provider Details

I. General information

NPI: 1912499666
Provider Name (Legal Business Name): CMARTIN THERAPY SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 WILDFLOWER LN
WYLIE TX
75098-6688
US

IV. Provider business mailing address

940 W FM 544 UNIT 1782
WYLIE TX
75098-3278
US

V. Phone/Fax

Practice location:
  • Phone: 972-379-8379
  • Fax:
Mailing address:
  • Phone: 972-379-8379
  • Fax: 214-764-3712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-09-5783
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA MARTIN
Title or Position: CCC-SLP, BCBA
Credential:
Phone: 972-379-8379