Provider Demographics
NPI:1811403652
Name:MARTINEZ, TONI T (LPC)
Entity Type:Individual
Prefix:MS
First Name:TONI
Middle Name:T
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53206-2818
Mailing Address - Country:US
Mailing Address - Phone:414-737-0377
Mailing Address - Fax:414-358-7158
Practice Address - Street 1:800 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2634
Practice Address - Country:US
Practice Address - Phone:414-737-0377
Practice Address - Fax:877-908-0564
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-15
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8146-125101YM0800X
WI3473-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health