MEDICARE: EMMA MARTINIE LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	23868	AZ

General Provider Information

NPI Number	:	1053274795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA MARTINIE LAC

Provider Business Mailing Address
First Line	:	2875 W RAY RD STE 6-138
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-3524
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2875 W RAY RD STE 6-138
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-3524
Country	:	US
Telephone Number	:	913-481-6916
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “ EMMA MARTINIE LAC” Practice Location

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