Healthcare Provider Details

I. General information

NPI: 1245585439
Provider Name (Legal Business Name): MELANIE ERIN MARTINEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 COLORADO AVE
LA JUNTA CO
81050-1592
US

IV. Provider business mailing address

201 COLORADO AVE
LA JUNTA CO
81050-1592
US

V. Phone/Fax

Practice location:
  • Phone: 719-241-3057
  • Fax: 719-241-3069
Mailing address:
  • Phone: 719-241-3057
  • Fax: 719-241-3069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: