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NPI Code Detail

MEDICARE: DR. TRACY DAWN MARTIN PHD, BCBA

MEDICARE: DR. TRACY DAWN MARTIN PHD, BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianTX
2103K00000XBehavior AnalystLA

General Provider Information

NPI Number : 1194464768
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TRACY DAWN MARTIN PHD, BCBA
Provider Business Mailing Address
First Line : 135 W MYRTLE ST
Second Line :
City : MAGNOLIA
State : MS
Zip : 39652-2805
Country : US
Telephone Number : 214-687-2330
Fax Number :
Provider Business Practice Location Address
First Line : 42124 VETERANS AVE
Second Line :
City : HAMMOND
State : LA
Zip : 70403-1427
Country : US
Telephone Number : 985-500-3240
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2022
Last Update Date : 01/14/2026

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