Provider Demographics
NPI:1588221709
Name:MARTINEZ, CARLOS MIGUEL (LMFTA)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:MIGUEL
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 S TELSHOR BLVD STE Q102
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4681
Mailing Address - Country:US
Mailing Address - Phone:575-888-4666
Mailing Address - Fax:888-473-9160
Practice Address - Street 1:755 S TELSHOR BLVD STE Q102
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4681
Practice Address - Country:US
Practice Address - Phone:575-888-4666
Practice Address - Fax:888-473-9160
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTL10204341106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty