Healthcare Provider Details

I. General information

NPI: 1740065978
Provider Name (Legal Business Name): HANA MARTIN LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 HIGH ST SE APT 102
ALBUQUERQUE NM
87102-3641
US

IV. Provider business mailing address

421 HIGH ST SE APT 102
ALBUQUERQUE NM
87102-3641
US

V. Phone/Fax

Practice location:
  • Phone: 505-507-4888
  • Fax:
Mailing address:
  • Phone: 505-507-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: