Healthcare Provider Details

I. General information

NPI: 1174835409
Provider Name (Legal Business Name): TERI M MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18484 US HIGHWAY 18 STE 210
APPLE VALLEY CA
92307-2319
US

IV. Provider business mailing address

18484 US HIGHWAY 18 STE 210
APPLE VALLEY CA
92307-2319
US

V. Phone/Fax

Practice location:
  • Phone: 760-946-9133
  • Fax: 760-946-9110
Mailing address:
  • Phone: 760-946-9133
  • Fax: 760-946-9110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW101451
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: