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General NPI Number Information
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NPI Number | 1801175880
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Entity Type | Individual
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Provider Name | KELSIE JADE TATUM MARTINEZ PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 08/09/2011
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 2201 K ST
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City | SACRAMENTO
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State | CA
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Zip | 95816-4922
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Country | US
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Telephone | 916-539-4589
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1863
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City | CAMARILLO
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State | CA
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Zip | 93011-1863
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY25975
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License Number State | CA
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