Provider Demographics
NPI:1386004760
Name:MARTINEZ, ANTONIO (MHA1)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MHA1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 SW GREELEY ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-4902
Mailing Address - Country:US
Mailing Address - Phone:509-386-8378
Mailing Address - Fax:
Practice Address - Street 1:331 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2224
Practice Address - Country:US
Practice Address - Phone:541-276-6207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health