Provider Demographics
NPI:1730639899
Name:ASHTON MARTINI LLC
Entity Type:Organization
Organization Name:ASHTON MARTINI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHTON
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-217-6604
Mailing Address - Street 1:8958 EDGEWORTH PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-3085
Mailing Address - Country:US
Mailing Address - Phone:702-217-6604
Mailing Address - Fax:
Practice Address - Street 1:7331 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1513
Practice Address - Country:US
Practice Address - Phone:702-217-6604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01338106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty