Healthcare Provider Details

I. General information

NPI: 1649895418
Provider Name (Legal Business Name): ANAIS MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 N CLAREMONT AVE FL 2
CHICAGO IL
60622-1702
US

IV. Provider business mailing address

1431 N CLAREMONT AVE FL 2
CHICAGO IL
60622-1702
US

V. Phone/Fax

Practice location:
  • Phone: 312-633-5890
  • Fax:
Mailing address:
  • Phone: 312-633-5890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: