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General NPI Number Information
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NPI Number | 1104795822
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Entity Type | Individual
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Provider Name | JESSICA MARTY
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Gender | Female
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Dates
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Enumeration Date | 10/31/2025
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 14100 N 83RD AVE STE 100
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City | PEORIA
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State | AZ
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Zip | 85381-4621
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Country | US
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Telephone | 623-583-0232
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Fax |
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Provider Business Mailing Address
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Address Line | 5151 N 16TH ST APT 4031
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City | PHOENIX
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State | AZ
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Zip | 85016-3817
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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