Provider Demographics
NPI:1477047470
Name:MARTINEZ, TERRI LYNN (LCMSW)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LCMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 NE 7TH AVE STE A206
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-4526
Mailing Address - Country:US
Mailing Address - Phone:369-718-8636
Mailing Address - Fax:
Practice Address - Street 1:649 S 8 MILE RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-7814
Practice Address - Country:US
Practice Address - Phone:989-948-1354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
MI68011135221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral