Healthcare Provider Details

I. General information

NPI: 1548902836
Provider Name (Legal Business Name): MARTINEZ COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E AVENUE B STE B
HUTCHINSON KS
67501-7463
US

IV. Provider business mailing address

405 CRESCENT BLVD
HUTCHINSON KS
67502-5515
US

V. Phone/Fax

Practice location:
  • Phone: 620-960-7822
  • Fax:
Mailing address:
  • Phone: 620-664-3901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAURA L. MARTINEZ
Title or Position: OWNER620-
Credential: LSCSW
Phone: 620-664-3901