Healthcare Provider Details

I. General information

NPI: 1003640772
Provider Name (Legal Business Name): SHERRI MARTINEZ LMFT, ADCII
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

32882 SYCAMORE CANYON LN
WINCHESTER CA
92596-5202
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-0063
  • Fax:
Mailing address:
  • Phone: 817-658-8755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number424811
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: