Provider Demographics
NPI:1093847915
Name:MARTIN, THOMAS E (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:E
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:110 W MARKET ST STE 204A
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-6206
Mailing Address - Country:US
Mailing Address - Phone:360-320-6304
Mailing Address - Fax:360-450-3023
Practice Address - Street 1:110 W MARKET ST STE 204A
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6206
Practice Address - Country:US
Practice Address - Phone:360-320-6304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 8854103T00000X
CAPSY8854103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP37720Medicare UPIN