Provider Demographics
NPI:1881802213
Name:MARTZ, STEPHEN (LCPC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MARTZ
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4813
Mailing Address - Country:US
Mailing Address - Phone:630-476-6425
Mailing Address - Fax:
Practice Address - Street 1:947 OXFORD RD
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-4813
Practice Address - Country:US
Practice Address - Phone:630-476-6425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional