Healthcare Provider Details

I. General information

NPI: 1194664409
Provider Name (Legal Business Name): ANJELICA MICHELLE MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6805 CORPORATE DR STE 120
COLORADO SPRINGS CO
80919-1977
US

IV. Provider business mailing address

6976 FOUNTAIN VISTA CIR
FOUNTAIN CO
80817-4710
US

V. Phone/Fax

Practice location:
  • Phone: 719-439-6017
  • Fax:
Mailing address:
  • Phone: 719-439-6017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: