Provider Demographics
NPI:1477848752
Name:MARTELL, CAROL K (LMHC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:K
Last Name:MARTELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 PLACITA LOMA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1613
Mailing Address - Country:US
Mailing Address - Phone:505-400-4936
Mailing Address - Fax:
Practice Address - Street 1:838 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3965
Practice Address - Country:US
Practice Address - Phone:505-227-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0129921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health