Individual
DAVID MICHAEL MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, MATS, LPC
Contact information
Practice address
1210 SE OAK ST, SUITE 3, PORTLAND, OR 97214-1427
(503) 880-1508
(971) 229-0928
Mailing address
2704 SE TIBBETTS ST, PORTLAND, OR 97202-2043
(503) 880-1508
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C3306
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500670213
—
OR
Enumeration date
06/19/2012
Last updated
02/26/2015
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