Provider Demographics
NPI:1225236219
Name:MEVS-MARTIN, NICOLE E (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:E
Last Name:MEVS-MARTIN
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 1:28924 OLD TOWN FRONT ST STE 203
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2857
Mailing Address - Country:US
Mailing Address - Phone:951-541-2031
Mailing Address - Fax:
Practice Address - Street 1:28924 OLD TOWN FRONT ST STE 203
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2857
Practice Address - Country:US
Practice Address - Phone:951-541-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 79622106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist