Provider Demographics
NPI:1659588200
Name:MARTIN, EVE SIMONE (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:EVE
Middle Name:SIMONE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6126 BALCOM AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-7233
Mailing Address - Country:US
Mailing Address - Phone:818-903-3934
Mailing Address - Fax:818-758-1360
Practice Address - Street 1:12669 ENCINITAS AVE
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-3635
Practice Address - Country:US
Practice Address - Phone:818-838-7710
Practice Address - Fax:818-838-7615
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT31711106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist