Provider Demographics
NPI:1457534372
Name:MARTINEZ, SCOTT M (BS,CDP)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:M
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:BS,CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 DUPONT ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-3100
Mailing Address - Country:US
Mailing Address - Phone:360-734-5458
Mailing Address - Fax:
Practice Address - Street 1:1200 DUPONT ST STE 1A
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3100
Practice Address - Country:US
Practice Address - Phone:360-734-5458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00005588101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)