Provider Demographics
NPI:1174703763
Name:LYTHGOE, MARTIN JAMES (CADC III, NCAC II)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:JAMES
Last Name:LYTHGOE
Suffix:
Gender:M
Credentials:CADC III, NCAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 MARIAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-7009
Mailing Address - Country:US
Mailing Address - Phone:805-377-7116
Mailing Address - Fax:
Practice Address - Street 1:286 MARIAN AVENUE
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-7009
Practice Address - Country:US
Practice Address - Phone:541-727-7088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-R-27101YA0400X
CAA3553789101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)