Healthcare Provider Details

I. General information

NPI: 1093588584
Provider Name (Legal Business Name): TYLOR J MARTINEZ M.S.,LMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 COLUMBIA PARK TRL
RICHLAND WA
99352-4770
US

IV. Provider business mailing address

1355 COLUMBIA PARK TRL
RICHLAND WA
99352-4770
US

V. Phone/Fax

Practice location:
  • Phone: 509-591-0462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC70092761
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: