Healthcare Provider Details

I. General information

NPI: 1619040979
Provider Name (Legal Business Name): JAMES ROBERT MARTINI MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAMES CARY OJEDA

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 S WASHINGTON ST SUITE 33A
GRAND FORKS ND
58201-6370
US

IV. Provider business mailing address

3383 PRIMROSE CT APT C20
GRAND FORKS ND
58201-5817
US

V. Phone/Fax

Practice location:
  • Phone: 701-746-4584
  • Fax: 701-746-1239
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number536-9-1-05
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: