Provider Demographics
NPI:1255959201
Name:MARTINEZ, ADRIENNA SCHELL
Entity type:Individual
Prefix:
First Name:ADRIENNA
Middle Name:SCHELL
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADRIENNA
Other - Middle Name:INEZ
Other - Last Name:SCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 S CHILSON ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-4461
Mailing Address - Country:US
Mailing Address - Phone:989-522-0344
Mailing Address - Fax:
Practice Address - Street 1:4600 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MI
Practice Address - Zip Code:48611-9369
Practice Address - Country:US
Practice Address - Phone:989-389-0265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIJ300630013283Medicaid