Healthcare Provider Details

I. General information

NPI: 1760370548
Provider Name (Legal Business Name): AMANDA JO MARTINEZ MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 N 10TH ST
KALAMAZOO MI
49009-5733
US

IV. Provider business mailing address

1090 N 10TH ST
KALAMAZOO MI
49009-5733
US

V. Phone/Fax

Practice location:
  • Phone: 269-375-4363
  • Fax: 269-375-4362
Mailing address:
  • Phone: 269-375-4363
  • Fax: 269-375-4362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6401223641
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: