Provider Demographics
NPI:1700060506
Name:MARTINEZ, P ROBERT LEE (LPCMHC)
Entity Type:Individual
Prefix:MR
First Name:P ROBERT
Middle Name:LEE
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LPCMHC
Other - Prefix:MR
Other - First Name:P ROBERT
Other - Middle Name:LEE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCMHC
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:TESUQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87574-0578
Mailing Address - Country:US
Mailing Address - Phone:505-983-3029
Mailing Address - Fax:505-983-3029
Practice Address - Street 1:05A CERRO DE PALOMAS
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506-0084
Practice Address - Country:US
Practice Address - Phone:505-983-3029
Practice Address - Fax:505-983-3029
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0033101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health