Provider Demographics
NPI:1467134551
Name:MARTINEZ, KATHLEEN THERESA
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:THERESA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32663 BUSH GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97446-9751
Mailing Address - Country:US
Mailing Address - Phone:503-780-0292
Mailing Address - Fax:
Practice Address - Street 1:32663 BUSH GARDEN DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:OR
Practice Address - Zip Code:97446-9751
Practice Address - Country:US
Practice Address - Phone:503-780-0292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health