Healthcare Provider Details

I. General information

NPI: 1710576434
Provider Name (Legal Business Name): JOSHUA MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2021
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1148 4TH ST
MUSKEGON MI
49441-1907
US

IV. Provider business mailing address

7125 POST RD
MONTAGUE MI
49437-9704
US

V. Phone/Fax

Practice location:
  • Phone: 231-726-2299
  • Fax:
Mailing address:
  • Phone: 231-736-9339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451017530
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6362004663
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: