Individual provider Active NPI

Isaac Benjamin Martin, M.A., LMHC

  • Mental Health Counselor
  • Evansville, IN
National Provider Identifier
1861786683
Registry record updated Aug 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
39002636A Issued in IN
Practice address
6008 Berry LN
Evansville, IN 47710-4381
Phone
(812) 205-8179
Fax
(812) 618-0959
NPI assigned
Jun 9, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Mental Health Counselor 101YM0800X 39002636A IN Primary

Addresses

Primary practice location

6008 Berry LN
Evansville, IN 47710-4381

Mailing address

6008 Berry LN
Evansville, IN 47710-4381
Phone (812) 205-8179

Other practice location 1

800 Cummings Ctr
Suite 266T
Beverly, MA 01915-6175
Phone (978) 921-1190

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

LicenseStateTypeSpecialty
39002636AINMDMental Health Counselor

NPI Registry JSON

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

{
    "created_epoch": "1307577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566950400000",
    "number": "1861786683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6008 BERRY LN",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477104381",
            "telephone_number": "812-205-8179",
            "fax_number": "812-618-0959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6008 BERRY LN",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477104381",
            "telephone_number": "812-205-8179",
            "fax_number": "812-618-0959"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Cummings Ctr",
            "address_2": "Suite 266T",
            "address_purpose": "LOCATION",
            "city": "Beverly",
            "state": "MA",
            "postal_code": "019156175",
            "country_code": "US",
            "telephone_number": "978-921-1190",
            "fax_number": "978-927-3724",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "ISAAC",
        "middle_name": "BENJAMIN",
        "credential": "M.A., LMHC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-09",
        "last_updated": "2019-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39002636A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2019; 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.