Provider Demographics
NPI:1144763350
Name:MARTINEZ, TAYLOR
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W MOANA LN
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4984
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 W MOANA LN
Practice Address - Street 2:SUITE D-1
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4984
Practice Address - Country:US
Practice Address - Phone:775-337-9359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health