Provider Demographics
NPI:1558811612
Name:MARTINEZ, DEANNA DARLENE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:DARLENE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W OKLAHOMA AVENUE
Mailing Address - Street 2:
Mailing Address - City:MANGUM
Mailing Address - State:OK
Mailing Address - Zip Code:73554
Mailing Address - Country:US
Mailing Address - Phone:866-926-6552
Mailing Address - Fax:
Practice Address - Street 1:222 W CYPRESS ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-3704
Practice Address - Country:US
Practice Address - Phone:580-280-1988
Practice Address - Fax:833-279-4266
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK10399101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator