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General NPI Number Information
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NPI Number | 1548432172
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Entity Type | Individual
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Provider Name | JASON K MARTIN PH.D., LMFT, LPC
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Gender | Male
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 07/14/2016
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Provider Practice Location Address
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Address Line | 515 N PENELOPE ST
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City | BELTON
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State | TX
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Zip | 76513-2675
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Country | US
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Telephone | 254-300-7565
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Fax | 254-933-3524
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Provider Business Mailing Address
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Address Line | 515 N PENELOPE ST
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City | BELTON
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State | TX
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Zip | 76513-2675
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Country | US
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Telephone | 254-300-7565
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Fax | 254-933-3524
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 201058
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 66109
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License Number State | TX
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