Provider Demographics
NPI:1093411126
Name:MARTINES, SHENDRI'ANNA RAYLYNN (LMHC)
Entity type:Individual
Prefix:
First Name:SHENDRI'ANNA
Middle Name:RAYLYNN
Last Name:MARTINES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4273 MONTGOMERY BLVD NE STE K220
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6748
Mailing Address - Country:US
Mailing Address - Phone:055-541-2835
Mailing Address - Fax:505-207-6167
Practice Address - Street 1:4253 MONTGOMERY BLVD NE # G130
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1106
Practice Address - Country:US
Practice Address - Phone:505-554-1283
Practice Address - Fax:505-207-6167
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2022-0977101YM0800X
NMCTB-20230543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM22884521Medicaid