Provider Demographics
NPI:1346923067
Name:MARTHEN, JEANNINE (MA, LPC, SCL)
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:
Last Name:MARTHEN
Suffix:
Gender:F
Credentials:MA, LPC, SCL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13820 HEARTHSTONE LN
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-3145
Mailing Address - Country:US
Mailing Address - Phone:248-505-7822
Mailing Address - Fax:
Practice Address - Street 1:43329 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1959
Practice Address - Country:US
Practice Address - Phone:248-600-5178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401222688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health