Provider Demographics
NPI:1861786683
Name:MARTIN, ISAAC BENJAMIN (MA, LMHC)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:BENJAMIN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6008 BERRY LN
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-4381
Mailing Address - Country:US
Mailing Address - Phone:812-205-8179
Mailing Address - Fax:812-618-0959
Practice Address - Street 1:6008 BERRY LN
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-4381
Practice Address - Country:US
Practice Address - Phone:812-205-8179
Practice Address - Fax:812-618-0959
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IN39002636A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health