Healthcare Provider Details

I. General information

NPI: 1841033958
Provider Name (Legal Business Name): ZACHARY GERALD MARTINCHEK LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 BAKER RD STE 100
DEXTER MI
48130-1196
US

IV. Provider business mailing address

2820 BAKER RD STE 100
DEXTER MI
48130-1196
US

V. Phone/Fax

Practice location:
  • Phone: 734-580-2920
  • Fax:
Mailing address:
  • Phone: 734-580-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401226424
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: