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General NPI Number Information
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NPI Number | 1710576434
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Entity Type | Individual
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Provider Name | JOSHUA MARTINEZ
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Gender | Male
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Dates
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Enumeration Date | 01/16/2021
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Last Update Date | 06/02/2023
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Provider Practice Location Address
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Address Line | 1148 4TH ST
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City | MUSKEGON
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State | MI
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Zip | 49441-1907
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Country | US
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Telephone | 231-726-2299
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Fax |
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Provider Business Mailing Address
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Address Line | 7125 POST RD
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City | MONTAGUE
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State | MI
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Zip | 49437-9704
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Country | US
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Telephone | 231-736-9339
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6362004663
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License Number State | MI
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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 | 6451017530
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License Number State | MI
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