Healthcare Provider Details

I. General information

NPI: 1427306125
Provider Name (Legal Business Name): JOSEPH PAUL MARTINO LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 E PARIS AVE SE STE 203
GRAND RAPIDS MI
49546-2426
US

IV. Provider business mailing address

1350 PINCKNEY RD
SARANAC MI
48881-9411
US

V. Phone/Fax

Practice location:
  • Phone: 616-929-0226
  • Fax:
Mailing address:
  • Phone: 616-929-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401012156
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: