Individual
DAVID LANCE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
125 N STATE ST, FAIRVIEW, UT 84629-5554
(435) 610-1810
Mailing address
152 NORTH 400 WEST, EPHRAIM, UT 84627-2131
(435) 283-8400
(435) 283-8401
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
5001946-3502
UT
1041C0700X
Clinical Social Worker
Primary
5001946-3501
UT
Other
Enumeration date
06/09/2008
Last updated
06/01/2023
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