MEDICARE: MR. MICHAEL C MARTINEZ L.C.P.C.

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	101Y00000X	Counselor	180008233	IL
2	101YM0800X	Mental Health Counselor	180008233	IL
3	101YP2500X	Professional Counselor	180008233	IL

General Provider Information

NPI Number	:	1376890756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL C MARTINEZ L.C.P.C.

Provider Business Mailing Address
First Line	:	3963 W BELMONT AVE UNIT 210
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-4339
Country	:	US
Telephone Number	:	773-946-9599
Fax Number	:

Provider Business Practice Location Address
First Line	:	3808 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3140
Country	:	US
Telephone Number	:	773-946-9599
Fax Number	:

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

Provider Enumeration Date	:	08/05/2012
Last Update Date	:	08/09/2012

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Directions to “ MR. MICHAEL C MARTINEZ L.C.P.C.” Practice Location

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