Provider Demographics
NPI:1417606492
Name:MARTINEZ, REBECCA L (LCPC)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:L
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 INDIAN GROVE LN
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-8252
Mailing Address - Country:US
Mailing Address - Phone:406-788-0478
Mailing Address - Fax:
Practice Address - Street 1:145 MILL TOWN LOOP STE B
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5144
Practice Address - Country:US
Practice Address - Phone:406-788-0478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT56508101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT236Medicaid