Provider Demographics
NPI:1104465699
Name:MARTZ, NICKOLAS (MED, LPC)
Entity type:Individual
Prefix:
First Name:NICKOLAS
Middle Name:
Last Name:MARTZ
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3939
Mailing Address - Country:US
Mailing Address - Phone:740-349-7511
Mailing Address - Fax:740-414-4050
Practice Address - Street 1:59 GRANT ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3939
Practice Address - Country:US
Practice Address - Phone:740-349-7511
Practice Address - Fax:740-414-4050
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2103531101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0385232Medicaid