Provider Demographics
NPI:1831728880
Name:MARTELLA, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MARTELLA
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 1:1454 NW ALMOND LOOP
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3808
Mailing Address - Country:US
Mailing Address - Phone:775-722-8659
Mailing Address - Fax:
Practice Address - Street 1:32650 STATE ROUTE 20 STE C206
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-2687
Practice Address - Country:US
Practice Address - Phone:425-774-8049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60824977106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist