Active NPI
David Evan Martin, MA LPC, LPCC
- Professional Counselor
- Colton, CA
National Provider Identifier
1306054986
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 3808
- Practice address
- 1330 E Cooley Dr
Colton, CA 92324-3905 - Phone
- (405) 761-5493
- NPI assigned
- May 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 4882 | OK | |
| Professional Counselor | 101YP2500X | 3808 | CA | Primary |
Addresses
Primary practice location
1330 E Cooley Dr
Colton, CA 92324-3905
Mailing address
555 Terracina Blvd
Redlands, CA 92373-5643
Phone (405) 761-5493
Other practice location 1
705 Cajon St
Redlands, CA 92373-5939
Phone (909) 283-3963
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LPCC3808 | Other | CA | BOARD OF BEHAVIORAL SCIENCES |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4882 | OK | MD | Professional Counselor |
| 3808 | CA | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615420800000",
"number": "1306054986",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 TERRACINA BLVD",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923735643",
"telephone_number": "405-761-5493"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1330 E COOLEY DR",
"city": "COLTON",
"state": "CA",
"postal_code": "923243905",
"telephone_number": "405-761-5493"
}
],
"practiceLocations": [
{
"address_1": "705 Cajon St",
"address_purpose": "LOCATION",
"city": "Redlands",
"state": "CA",
"postal_code": "923735939",
"country_code": "US",
"telephone_number": "909-283-3963",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MARTIN",
"first_name": "DAVID",
"middle_name": "EVAN",
"credential": "MA LPC, LPCC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-18",
"last_updated": "2021-03-11",
"certification_date": "2021-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OK",
"license": "4882",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CA",
"license": "3808",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF BEHAVIORAL SCIENCES",
"identifier": "LPCC3808",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Colton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.