Provider Demographics
NPI:1144912338
Name:MARTIN, LYDIA B (MS, RBT)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:B
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6394 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1506
Mailing Address - Country:US
Mailing Address - Phone:800-345-0448
Mailing Address - Fax:
Practice Address - Street 1:1220 ASHLEY CIR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3338
Practice Address - Country:US
Practice Address - Phone:800-345-0448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-22-250259106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician