Healthcare Provider Details

I. General information

NPI: 1376982157
Provider Name (Legal Business Name): EVA ROSEANNE MARTINEZ-DEVOURSNEY LLP, LLPC, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 OAKRIDGE RD
MUSKEGON MI
49441-4023
US

IV. Provider business mailing address

885 OAKRIDGE RD MUSKEGON
NORTON SHORES MI
49444-3719
US

V. Phone/Fax

Practice location:
  • Phone: 231-780-8252
  • Fax:
Mailing address:
  • Phone: 231-780-8252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number#6401009354
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301012846
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: