Provider Demographics
NPI:1124785399
Name:MARTINEZ, JEANA (MS, LMFT 129165)
Entity type:Individual
Prefix:
First Name:JEANA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS, LMFT 129165
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 LAVENDER CT
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582-3717
Mailing Address - Country:US
Mailing Address - Phone:951-313-2270
Mailing Address - Fax:
Practice Address - Street 1:2228 LAVENDER CT
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-3717
Practice Address - Country:US
Practice Address - Phone:951-313-2270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129165101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health