Healthcare Provider Details

I. General information

NPI: 1770028912
Provider Name (Legal Business Name): SEAN MARTINY LCPC, LPHA, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2016
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 S 5TH ST
GENEVA IL
60134-2111
US

IV. Provider business mailing address

150 ASPEN CT
NORTH AURORA IL
60542-3319
US

V. Phone/Fax

Practice location:
  • Phone: 303-917-4643
  • Fax:
Mailing address:
  • Phone: 303-917-4643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.010564
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180.010564
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: