MEDICARE: MR. DAVID L MARTINEZ M.S.

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	101YP2500X	Professional Counselor	LPC-10348	AZ

General Provider Information

NPI Number	:	1760520910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID L MARTINEZ M.S.

Provider Business Mailing Address
First Line	:	2969 CAMINO DEL RIO
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7887
Country	:	US
Telephone Number	:	928-763-5901
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 HIGHWAY 95 STE 104
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7802
Country	:	US
Telephone Number	:	928-763-0250
Fax Number	:

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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