Provider Demographics
NPI:1619040979
Name:MARTINI, JAMES ROBERT (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:MARTINI
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:CARY
Other - Last Name:OJEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3383 PRIMROSE CT APT C20
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1726 S WASHINGTON ST
Practice Address - Street 2:SUITE 33A
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6370
Practice Address - Country:US
Practice Address - Phone:701-746-4584
Practice Address - Fax:701-746-1239
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND536-9-1-05101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor