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General NPI Number Information
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NPI Number | 1386181451
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Entity Type | Individual
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Provider Name | ANGIE MARTIN
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Gender | Female
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Dates
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Enumeration Date | 01/26/2017
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 634 GROVEVIEW LN
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City | LA CANADA FLINTRIDGE
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State | CA
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Zip | 91011-2634
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Country | US
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Telephone | 818-790-2438
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 SUNVUE PL 2
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City | LOS ANGELES
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State | CA
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Zip | 90012-1563
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.012667
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2688
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License Number State | CA
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