MEDICARE: MR. SCOTT M MARTINEZ BS,CDP

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	00005588	WA

General Provider Information

NPI Number	:	1457534372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT M MARTINEZ BS,CDP

Provider Business Mailing Address
First Line	:	1200 DUPONT ST STE 1A
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-3100
Country	:	US
Telephone Number	:	360-734-5458
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 DUPONT ST STE 1A
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-3100
Country	:	US
Telephone Number	:	360-734-5458
Fax Number	:

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

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	04/26/2012

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