Provider Demographics
NPI:1831903582
Name:MARTINEZ, JAMMIE ERNESTINE (CAS)
Entity type:Individual
Prefix:
First Name:JAMMIE
Middle Name:ERNESTINE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 LAVA LN
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-3578
Mailing Address - Country:US
Mailing Address - Phone:719-589-5176
Mailing Address - Fax:
Practice Address - Street 1:2265 LAVA LN
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-3578
Practice Address - Country:US
Practice Address - Phone:719-589-5176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0021072101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor