Provider Demographics
NPI:1942639414
Name:MARTINEZ, ANTHONY L (LAC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:L
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 E MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2611
Mailing Address - Country:US
Mailing Address - Phone:602-820-4089
Mailing Address - Fax:602-685-1944
Practice Address - Street 1:1110 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2611
Practice Address - Country:US
Practice Address - Phone:602-820-4089
Practice Address - Fax:602-685-1944
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-14332101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor