Provider Demographics
NPI:1316718760
Name:MARTIN, GILBERT T III (LPC-SA, LMFT)
Entity type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:T
Last Name:MARTIN
Suffix:III
Gender:M
Credentials:LPC-SA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 TRACE WEST RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-9145
Mailing Address - Country:US
Mailing Address - Phone:318-816-8427
Mailing Address - Fax:
Practice Address - Street 1:208 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4510
Practice Address - Country:US
Practice Address - Phone:318-816-8427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA453106H00000X
LA1203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist