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General NPI Number Information
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NPI Number | 1174703763
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Entity Type | Individual
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Provider Name | MARTIN JAMES LYTHGOE CADC III, NCAC II
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Gender | Male
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Dates
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Enumeration Date | 11/12/2007
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 286 MARIAN AVENUE
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City | CENTRAL POINT
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State | OR
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Zip | 97502-7009
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Country | US
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Telephone | 541-727-7088
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Fax |
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Provider Business Mailing Address
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Address Line | 286 MARIAN AVENUE
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City | CENTRAL POINT
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State | OR
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Zip | 97502-7009
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Country | US
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Telephone | 805-377-7116
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 24-R-27
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | A3553789
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License Number State | CA
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