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General NPI Number Information
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NPI Number | 1962485912
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Entity Type | Individual
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Provider Name | TERRY MARTIN MARTINEZ SR. LCSW
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Gender | Male
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 4301 WILSON ST
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City | FORT SILL
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State | OK
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Zip | 73503-4472
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Country | US
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Telephone | 580-442-3084
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Fax |
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Provider Business Mailing Address
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Address Line | 550 POPE AVE MUNSON ARMY HEALTH CENTER ATTN MCXN COD MS COTTON
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City | FORT LEAVENWORTH
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State | KS
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Zip | 66027-2332
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Country | US
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Telephone | 913-684-6562
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Fax | 913-684-6208
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 357
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License Number State | WY
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