Provider Demographics
NPI:1669098620
Name:MARTINEZ, HOLLIS OLIVIA
Entity type:Individual
Prefix:
First Name:HOLLIS
Middle Name:OLIVIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 E COBBLESTONES LN
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9581
Mailing Address - Country:US
Mailing Address - Phone:567-868-5232
Mailing Address - Fax:
Practice Address - Street 1:1070 COMMERCE DR STE 101
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5231
Practice Address - Country:US
Practice Address - Phone:419-482-8382
Practice Address - Fax:855-319-1493
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health