Provider Demographics
NPI:1053411777
Name:SEITZ, MARTIN LINDLEY (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:LINDLEY
Last Name:SEITZ
Suffix:
Gender:
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARTY
Other - Middle Name:
Other - Last Name:SEITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:500 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMORE
Mailing Address - State:KY
Mailing Address - Zip Code:40390-1014
Mailing Address - Country:US
Mailing Address - Phone:859-858-9201
Mailing Address - Fax:
Practice Address - Street 1:2401 REGENCY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2914
Practice Address - Country:US
Practice Address - Phone:859-309-0309
Practice Address - Fax:859-309-0914
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY725103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY11639140OtherCAQH