Provider Demographics
NPI:1235291527
Name:MARTIN, ROXANNE HARRELL (LMFT 46524)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:HARRELL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMFT 46524
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1058
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-1058
Mailing Address - Country:US
Mailing Address - Phone:707-784-4900
Mailing Address - Fax:707-399-4957
Practice Address - Street 1:2101 COURAGE DR
Practice Address - Street 2:SOLANO COUNTY CHILDREN'S MENTAL HEALTH
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6717
Practice Address - Country:US
Practice Address - Phone:707-784-4900
Practice Address - Fax:707-399-4957
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46524106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2582OtherMED-I-CAL BILLING NUMBER
CA4383OtherMED-I-CAL BILLING NUMBER