Provider Demographics
NPI:1245002740
Name:MARTINEZ, STEPHAN ALEXANDER
Entity type:Individual
Prefix:MR
First Name:STEPHAN
Middle Name:ALEXANDER
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 E OHIO ST
Mailing Address - Street 2:
Mailing Address - City:WALTERS
Mailing Address - State:OK
Mailing Address - Zip Code:73572-2825
Mailing Address - Country:US
Mailing Address - Phone:580-574-3855
Mailing Address - Fax:
Practice Address - Street 1:300 N MERIDIAN AVE STE 201N
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-6553
Practice Address - Country:US
Practice Address - Phone:405-601-8876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health