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NPI Code Detail

MEDICARE: CHANIKA NICOLE MARTIN PSY.D.

MEDICARE:   CHANIKA NICOLE MARTIN  PSY.D.
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
1103TC0700XClinical Psychologist36956TX

General Provider Information

NPI Number : 1770962995
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANIKA NICOLE MARTIN PSY.D.
Provider Business Mailing Address
First Line : 641 N WALNUT AVE
Second Line :
City : NEW BRAUNFELS
State : TX
Zip : 78130-7925
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 641 N WALNUT AVE
Second Line :
City : NEW BRAUNFELS
State : TX
Zip : 78130-7925
Country : US
Telephone Number : 830-730-6090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2015
Last Update Date : 05/20/2015

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Directions to “ CHANIKA NICOLE MARTIN PSY.D.” Practice Location

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