Provider Demographics
NPI:1942569140
Name:MARTIN, JONI (MSC/SC)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSC/SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16212 GINGER AVE
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:CO
Mailing Address - Zip Code:80542-6018
Mailing Address - Country:US
Mailing Address - Phone:303-829-2884
Mailing Address - Fax:
Practice Address - Street 1:1707 MAIN ST
Practice Address - Street 2:220
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7407
Practice Address - Country:US
Practice Address - Phone:303-829-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12706101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor