Individual
SHANE DOUGLAS MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
1333 NW 9TH ST, PRINEVILLE, OR 97754-1482
(541) 447-2631
Mailing address
1333 NW 9TH ST, PRINEVILLE, OR 97754-1482
(541) 447-2631
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OR
Other
Enumeration date
08/30/2018
Last updated
08/30/2018
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