Provider Demographics
NPI:1104998418
Name:MARTIN, TIMOTHY L (MS, LMFT, CMFT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MS, LMFT, CMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 S 18ST CIRCLE
Mailing Address - Street 2:#9
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701
Mailing Address - Country:US
Mailing Address - Phone:402-617-0242
Mailing Address - Fax:
Practice Address - Street 1:923 EAST NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701
Practice Address - Country:US
Practice Address - Phone:402-379-0040
Practice Address - Fax:402-379-0759
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1428LMHP101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
8699OtherCIGNA