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NPI Code Detail

MEDICARE: HOLLIS OLIVIA MARTINEZ

MEDICARE: HOLLIS OLIVIA MARTINEZ
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1669098620
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLIS OLIVIA MARTINEZ
Provider Business Mailing Address
First Line : 6002 E COBBLESTONES LN
Second Line :
City : SYLVANIA
State : OH
Zip : 43560-9581
Country : US
Telephone Number : 567-868-5232
Fax Number :
Provider Business Practice Location Address
First Line : 1070 COMMERCE DR STE 101
Second Line :
City : PERRYSBURG
State : OH
Zip : 43551-5231
Country : US
Telephone Number : 419-482-8382
Fax Number : 855-319-1493
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2020
Last Update Date : 06/24/2020

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Directions to “ HOLLIS OLIVIA MARTINEZ ” Practice Location

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