Healthcare Provider Details

I. General information

NPI: 1134754013
Provider Name (Legal Business Name): LUIS MARTINEZ LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1973 GARDEN AVENUE
EUGENE OR
97403
US

IV. Provider business mailing address

2948 GAME FARM ROAD
SPRINGFIELD OR
97477
US

V. Phone/Fax

Practice location:
  • Phone: 541-343-7643
  • Fax: 541-344-5255
Mailing address:
  • Phone: 541-337-8853
  • Fax: 541-344-5255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC5560
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberC5560
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: