Provider Demographics
NPI:1447702477
Name:MARTIN, SCOTT TRAVIS (LPC-S)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:TRAVIS
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4848 LEMMON AVE
Mailing Address - Street 2:#150
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-1400
Mailing Address - Country:US
Mailing Address - Phone:214-663-2209
Mailing Address - Fax:
Practice Address - Street 1:5750 CEDAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6802
Practice Address - Country:US
Practice Address - Phone:214-393-3640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16271101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional