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General NPI Number Information
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NPI Number | 1144930868
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Entity Type | Individual
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Provider Name | JON SEBASTIAN MARTINEZ
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Gender | Male
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 610 N BROADWAY
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City | GREEN BAY
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State | WI
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Zip | 54303-3426
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Country | US
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Telephone | 956-206-1130
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Fax |
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Provider Business Mailing Address
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Address Line | 1686 BIRCHWOOD DR
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City | GREEN BAY
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State | WI
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Zip | 54304-2937
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Country | US
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Telephone | 956-206-1130
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11318125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 87416
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License Number State | TX
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