MEDICARE: LESTER WYLIE MARTIN LPC

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	101YP2500X	Professional Counselor	62999	TX

General Provider Information

NPI Number	:	1558597401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESTER WYLIE MARTIN LPC

Provider Business Mailing Address
First Line	:	PO BOX 146
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75483-0146
Country	:	US
Telephone Number	:	903-885-2776
Fax Number	:	903-885-3613

Provider Business Practice Location Address
First Line	:	2121 MAIN ST
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-3616
Country	:	US
Telephone Number	:	903-885-2776
Fax Number	:	903-885-3613

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

Provider Enumeration Date	:	06/05/2009
Last Update Date	:	01/30/2017

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