Provider Demographics
NPI:1396438271
Name:MARTINEZ MUELLER, JUAN JOSE (LPC MHSP)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:JOSE
Last Name:MARTINEZ MUELLER
Suffix:
Gender:M
Credentials:LPC MHSP
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:JOSE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC MHSP
Mailing Address - Street 1:3209 MIDDLEFORD DR
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-6167
Mailing Address - Country:US
Mailing Address - Phone:909-283-8095
Mailing Address - Fax:
Practice Address - Street 1:3209 MIDDLEFORD DR
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-6167
Practice Address - Country:US
Practice Address - Phone:909-283-8095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6224101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health