Healthcare Provider Details

I. General information

NPI: 1720234255
Provider Name (Legal Business Name): CHINEZE JUAN MARTINEZ LMHC, CAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 12/24/2020
Certification Date: 12/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12651 S DIXIE HWY STE 308
PINECREST FL
33156-5961
US

IV. Provider business mailing address

915 ROSA L PARKS BLVD
NASHVILLE TN
37208-2621
US

V. Phone/Fax

Practice location:
  • Phone: 305-219-6458
  • Fax:
Mailing address:
  • Phone: 615-460-4112
  • 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: