Mark Randall Martin, L.C.P.C.

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

1505 Eastland Dr
Emp II LL 1000
Bloomington, IL 61701-3534

Phone

(309) 663-1623

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467563205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 BROOKSHIRE GRN",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046211",
            "telephone_number": "309-663-8243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 EASTLAND DR",
            "address_2": "EMP II LL 1000",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013534",
            "telephone_number": "309-663-1623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "MARK",
        "middle_name": "RANDALL",
        "name_prefix": "Mr.",
        "credential": "L.C.P.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jalyn L Marshall
• Kimberly Diana Martin-Corcoran
• Alyssa Julianna Martin
• Ann K Martin, DPT
• Kenneth Noel Martin, MA, LPC
• William M Martin, R.PH.
• Polly Sue Masemore, PT
• Masengale Counseling, PLLC
• Kenneth B Masi, PHD,
• Rebekah Anne Mason, PA-C

• Professional Counselor in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.