Healthcare Provider Details

I. General information

NPI: 1093411126
Provider Name (Legal Business Name): SHENDRI'ANNA RAYLYNN MARTINES LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4253 MONTGOMERY BLVD NE # G130
ALBUQUERQUE NM
87109-1106
US

IV. Provider business mailing address

4273 MONTGOMERY BLVD NE STE K220
ALBUQUERQUE NM
87109-6748
US

V. Phone/Fax

Practice location:
  • Phone: 505-554-1283
  • Fax: 505-207-6167
Mailing address:
  • Phone: 55-541-2835
  • Fax: 505-207-6167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2022-0977
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-20230543
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: