Faitak, Martin Thomas

Faitak, Martin Thomas is an individual health care provider with primary practice located at 204 N East Ave , Fayetteville AR 72701-5225. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Faitak, Martin Thomas can be contacted via phone (479) 442-0763.

Contact Information

Primary practice address
204 N East Ave Fayetteville AR 72701-5225
Phone: (479) 442-0763
Fax: (479) 442-5587
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 88-12P Arkansas

Profile Details

NPI number 1659351781
LBN Legal business name Faitak, Martin Thomas
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 17th, 2006
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659351781 NPPES
Arkansas Other 56390 BLUE CROSS BLUE SHIELD ID

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