Provider Demographics
NPI:1710776083
Name:MARTIN, FAITH R (MS, LAC, NCC, CSCS)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:
Credentials:MS, LAC, NCC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 N SETON
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-5453
Mailing Address - Country:US
Mailing Address - Phone:623-281-7475
Mailing Address - Fax:
Practice Address - Street 1:860 N SETON
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-5453
Practice Address - Country:US
Practice Address - Phone:623-281-7475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-22127101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health