MEDICARE: MR. SEBASTIAN DASHIELL MARTIN AMFT 161642

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	106H00000X	Marriage & Family Therapist	161642	CA

General Provider Information

NPI Number	:	1861327611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SEBASTIAN DASHIELL MARTIN AMFT 161642

Provider Business Mailing Address
First Line	:	294 SANTA ANA AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-3559
Country	:	US
Telephone Number	:	424-702-2755
Fax Number	:

Provider Business Practice Location Address
First Line	:	294 SANTA ANA AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-3559
Country	:	US
Telephone Number	:	424-702-2755
Fax Number	:

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

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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