Provider Demographics
NPI:1811769151
Name:ALEJANDRO MARTINEZ JR. PLLC
Entity type:Organization
Organization Name:ALEJANDRO MARTINEZ JR. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:928-848-6413
Mailing Address - Street 1:PO BOX 12052
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-2052
Mailing Address - Country:US
Mailing Address - Phone:928-848-6413
Mailing Address - Fax:
Practice Address - Street 1:1215 GAIL GARDNER WAY
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-3423
Practice Address - Country:US
Practice Address - Phone:928-848-6413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)