MEDICARE: MISS REBECCA L MARTINEZ LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	56508	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417606492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS REBECCA L MARTINEZ LCPC

Provider Business Mailing Address
First Line	:	108 INDIAN GROVE LN
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-8252
Country	:	US
Telephone Number	:	406-788-0478
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 MILL TOWN LOOP STE B
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-5144
Country	:	US
Telephone Number	:	406-788-0478
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2022
Last Update Date	:	11/30/2022

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