Provider Demographics
NPI:1205644903
Name:MARTIN, HALIE ELIZABETH (AMFT #137584)
Entity type:Individual
Prefix:
First Name:HALIE
Middle Name:ELIZABETH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:AMFT #137584
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511B MAMMOTH AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2916
Mailing Address - Country:US
Mailing Address - Phone:765-366-0248
Mailing Address - Fax:
Practice Address - Street 1:29995 TECHNOLOGY DR STE 101A
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2633
Practice Address - Country:US
Practice Address - Phone:951-816-1778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137584106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist