Provider Demographics
NPI:1083148266
Name:MARTINEZ, MEGHAN MICHELLE (MA, LMFT)
Entity Type:Individual
Prefix:MISS
First Name:MEGHAN
Middle Name:MICHELLE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16935 W BERNARDO DR STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1635
Mailing Address - Country:US
Mailing Address - Phone:858-633-3382
Mailing Address - Fax:858-831-8340
Practice Address - Street 1:16935 W BERNARDO DR STE 208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1635
Practice Address - Country:US
Practice Address - Phone:858-633-3382
Practice Address - Fax:858-831-8340
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-14
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA92751106H00000X
CALMFT120644106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health