Healthcare Provider Details

I. General information

NPI: 1316760549
Provider Name (Legal Business Name): VANESSA ANGELINA MARTINEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 E EMPIRE ST
CORTEZ CO
81321-2802
US

IV. Provider business mailing address

1536 ARROWHEAD LN
CORTEZ CO
81321-9545
US

V. Phone/Fax

Practice location:
  • Phone: 970-565-7946
  • Fax: 970-565-9005
Mailing address:
  • Phone: 970-570-5301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0021503
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: