Provider Demographics
NPI:1174703763
Name:LYTHGOE, MARTIN J (CADC II, NCAC II)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:J
Last Name:LYTHGOE
Suffix:
Gender:M
Credentials:CADC II, NCAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-1513
Mailing Address - Country:US
Mailing Address - Phone:805-377-7116
Mailing Address - Fax:
Practice Address - Street 1:4050 MARKET ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5625
Practice Address - Country:US
Practice Address - Phone:805-654-4122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3553789101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)