Provider Demographics
NPI:1194479741
Name:MARTINEZ, STEVEN ANTHONY JR (LAC)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ANTHONY
Last Name:MARTINEZ
Suffix:JR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1028 COTTONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LAS ANIMAS
Mailing Address - State:CO
Mailing Address - Zip Code:81054-1819
Mailing Address - Country:US
Mailing Address - Phone:719-980-0237
Mailing Address - Fax:
Practice Address - Street 1:11000 COUNTY ROAD GG.5
Practice Address - Street 2:
Practice Address - City:LAS ANIMAS
Practice Address - State:CO
Practice Address - Zip Code:81054-9488
Practice Address - Country:US
Practice Address - Phone:719-456-2600
Practice Address - Fax:719-456-2606
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0001643101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)