Provider Demographics
NPI:1730472747
Name:MARTINEZ, JESSE (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 MONTE CARLO WAY
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-1825
Mailing Address - Country:US
Mailing Address - Phone:831-320-1089
Mailing Address - Fax:
Practice Address - Street 1:4000 W METROPOLITAN DR # 401
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3504
Practice Address - Country:US
Practice Address - Phone:714-935-6117
Practice Address - Fax:714-935-6066
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT97685106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist