Provider Demographics
NPI:1295927523
Name:MARTIN, HERBERT PETER (LPC, LMFT)
Entity type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:PETER
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 JACKSON AVE E
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-3809
Mailing Address - Country:US
Mailing Address - Phone:662-236-5773
Mailing Address - Fax:662-236-5844
Practice Address - Street 1:401 JACKSON AVE E
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-3809
Practice Address - Country:US
Practice Address - Phone:662-236-5773
Practice Address - Fax:662-236-5844
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0644101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional