Provider Demographics
NPI:1225156656
Name:MARTINEZ, CHRISTINE WILLIS (MA LPC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:WILLIS
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2027 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5101
Mailing Address - Country:US
Mailing Address - Phone:303-447-6447
Mailing Address - Fax:
Practice Address - Street 1:2027 11TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5101
Practice Address - Country:US
Practice Address - Phone:303-447-6447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1972101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional