Healthcare Provider Details

I. General information

NPI: 1073326005
Provider Name (Legal Business Name): ANTOINETTE MARIE MARTINEZ LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7493 N ORACLE RD
TUCSON AZ
85704-6343
US

IV. Provider business mailing address

26 SHERBUNDY ST
SIERRA VISTA AZ
85635-1425
US

V. Phone/Fax

Practice location:
  • Phone: 520-638-6000
  • Fax:
Mailing address:
  • Phone: 520-678-1889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-25013
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: