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General NPI Number Information
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NPI Number | 1164438941
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Entity Type | Individual
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Provider Name | DEIRDRE K MARTIN LMHC
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Gender | Female
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 905 E MARTIN LUTHER KING JR DR SUITE 290
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-4864
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Country | US
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Telephone | 813-252-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 905 E MARTIN LUTHER KING JR DR SUITE 290
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-4864
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Country | US
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Telephone | 813-252-0900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 5462
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License Number State | FL
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