Healthcare Provider Details

I. General information

NPI: 1407395403
Provider Name (Legal Business Name): JESSICA MICHELLE MARTINEZ M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 N PARKWAY DR
FRESNO CA
93728-2724
US

IV. Provider business mailing address

949 N PARKWAY DR
FRESNO CA
93728-2724
US

V. Phone/Fax

Practice location:
  • Phone: 559-500-1999
  • Fax:
Mailing address:
  • Phone: 559-500-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT115986
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: