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General NPI Number Information
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NPI Number | 1538372974
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Entity Type | Individual
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Provider Name | SELMA MARTINEZ BCBA
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Gender | Female
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 10769 BROADWAY STE 208
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City | CROWN POINT
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State | IN
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Zip | 46307-7316
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Country | US
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Telephone | 855-690-2192
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Fax | 888-972-2192
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Provider Business Mailing Address
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Address Line | 2104 DAYBREAK DR
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City | LAKE IN THE HILLS
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State | IL
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Zip | 60156-6409
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Country | US
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Telephone | 855-690-2192
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Fax | 888-972-2192
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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 | 1021012
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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