Provider Demographics
NPI:1114001724
Name:MARTELLI, JOAN CARSON (LPC)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:CARSON
Last Name:MARTELLI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:DIANE
Other - Last Name:ISTOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:425 ELLSWORTH ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2362
Mailing Address - Country:US
Mailing Address - Phone:541-926-1620
Mailing Address - Fax:541-928-8918
Practice Address - Street 1:425 ELLSWORTH ST SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2362
Practice Address - Country:US
Practice Address - Phone:541-926-1620
Practice Address - Fax:541-928-8918
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1830101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health