MEDICARE: MR. WILLIAM M MARTIN M.A.P.C.

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
1	101YM0800X	Mental Health Counselor	0157821	NM

General Provider Information

NPI Number	:	1548603392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM M MARTIN M.A.P.C.

Provider Business Mailing Address
First Line	:	2301 7TH ST STE A
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4966
Country	:	US
Telephone Number	:	505-454-9611
Fax Number	:	505-454-8079

Provider Business Practice Location Address
First Line	:	2301 7TH ST STE A
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4966
Country	:	US
Telephone Number	:	505-454-9611
Fax Number	:	505-454-8079

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2013
Last Update Date	:	04/11/2013

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