Healthcare Provider Details

I. General information

NPI: 1245771633
Provider Name (Legal Business Name): BROOKE MARTINEZ M.S. LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE ANDERSON M.S.

II. Dates (important events)

Enumeration Date: 03/17/2017
Last Update Date: 01/05/2023
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 SHADY LANE DR
WADENA MN
56482-3093
US

IV. Provider business mailing address

2275 S MAIN ST STE 201
CORONA CA
92882-5303
US

V. Phone/Fax

Practice location:
  • Phone: 182-319-6008
  • Fax: 218-632-6583
Mailing address:
  • Phone: 951-279-3222
  • Fax: 951-279-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: