MEDICARE: CRYSTAL MARTINEZ LMFT105725

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	IMF72452	CA
2	106H00000X	Marriage & Family Therapist	LMFT105725	CA

General Provider Information

NPI Number	:	1427489194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL MARTINEZ LMFT105725

Provider Business Mailing Address
First Line	:	2370 SKYWAY DR STE 104
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93455-1133
Country	:	US
Telephone Number	:	805-934-3305
Fax Number	:

Provider Business Practice Location Address
First Line	:	2370 SKYWAY DR STE 104
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93455-1133
Country	:	US
Telephone Number	:	805-934-3305
Fax Number	:

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

Provider Enumeration Date	:	12/06/2013
Last Update Date	:	03/16/2021

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