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NPI Code Detail

MEDICARE: ALLIE NICOLE MARTIN LAC

MEDICARE: ALLIE NICOLE MARTIN LAC
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
1101YM0800XMental Health CounselorA2604007AR

General Provider Information

NPI Number : 1760313589
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLIE NICOLE MARTIN LAC
Provider Business Mailing Address
First Line : 820 1/2 N SPRUCE ST
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-1955
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10311 W MARKHAM ST
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-2135
Country : US
Telephone Number : 501-781-2230
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2026
Last Update Date : 05/28/2026

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Directions to “ ALLIE NICOLE MARTIN LAC” Practice Location

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