Provider Demographics
NPI:1700445962
Name:MARTINEZ, AVA CHRISTINE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:AVA
Middle Name:CHRISTINE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11645 MONTANA AVE APT 224
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4644
Mailing Address - Country:US
Mailing Address - Phone:415-377-0354
Mailing Address - Fax:
Practice Address - Street 1:11645 MONTANA AVE APT 224
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-4644
Practice Address - Country:US
Practice Address - Phone:315-377-0354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110447101Y00000X, 106H00000X
CA126449106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor