Provider Demographics
NPI:1518030451
Name:MARTINEZ, SHELLEY DARLENE (MA, LPCC, NCC)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:DARLENE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MA, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 GRANDE BLVD SE STE C
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1654
Mailing Address - Country:US
Mailing Address - Phone:505-410-1773
Mailing Address - Fax:
Practice Address - Street 1:2320 GRANDE BLVD SE STE C
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1654
Practice Address - Country:US
Practice Address - Phone:505-410-1773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH005695101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health