Provider Demographics
NPI:1508480872
Name:MARTINEZ MINDFUL HEALING LLC
Entity Type:Organization
Organization Name:MARTINEZ MINDFUL HEALING LLC
Other - Org Name:MARIA NANCY MARTINEZ
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:NANCY
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-305-7404
Mailing Address - Street 1:2506 NORMAN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-1549
Mailing Address - Country:US
Mailing Address - Phone:405-305-7404
Mailing Address - Fax:
Practice Address - Street 1:4200 PERIMETER CENTER DR STE 245
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2322
Practice Address - Country:US
Practice Address - Phone:405-305-7404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIA NANCY MARTINEZ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-03
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)