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NPI Code Detail

MEDICARE: TYRONE MARTIN CDCA, PRS

MEDICARE: TYRONE MARTIN CDCA, PRS
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.194854OH
2175T00000XPeer SpecialistAPS.005867OH

General Provider Information

NPI Number : 1215866702
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYRONE MARTIN CDCA, PRS
Provider Business Mailing Address
First Line : 2065 STONERIDGE DR
Second Line :
City : CIRCLEVILLE
State : OH
Zip : 43113-8956
Country : US
Telephone Number : 740-500-1391
Fax Number :
Provider Business Practice Location Address
First Line : 2065 STONERIDGE DR
Second Line :
City : CIRCLEVILLE
State : OH
Zip : 43113-8956
Country : US
Telephone Number : 740-500-1391
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2026
Last Update Date : 05/19/2026

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Directions to “ TYRONE MARTIN CDCA, PRS” Practice Location

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