Individual
GARY A MARTIN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
916 W SELDON LN, PHOENIX, AZ 85021-4450
(602) 256-9599
(480) 585-6109
Mailing address
PO BOX 6605, SCOTTSDALE, AZ 85261-6605
(602) 256-9599
(480) 585-6109
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1049
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
73123302
AHCCCS
AZ
Enumeration date
10/11/2005
Last updated
07/08/2007
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