Provider Demographics
NPI:1417657503
Name:MARTIN, MEI-LING JEREZ (AMFT, APCC)
Entity type:Individual
Prefix:
First Name:MEI-LING
Middle Name:JEREZ
Last Name:MARTIN
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57280 YUCCA TRL UNIT 701
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92286-3230
Mailing Address - Country:US
Mailing Address - Phone:760-219-2438
Mailing Address - Fax:
Practice Address - Street 1:57280 YUCCA TRL UNIT 701
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92286-3230
Practice Address - Country:US
Practice Address - Phone:760-219-2438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC15827101YP2500X
CAAMFT144906106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional