Provider Demographics
NPI:1972940542
Name:MICHAEL C. MARTINEZ LCPC
Entity type:Organization
Organization Name:MICHAEL C. MARTINEZ LCPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-234-8133
Mailing Address - Street 1:3963 W BELMONT AVE
Mailing Address - Street 2:#210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5149
Mailing Address - Country:US
Mailing Address - Phone:773-234-8133
Mailing Address - Fax:
Practice Address - Street 1:79 W MONROE ST
Practice Address - Street 2:#920
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-4901
Practice Address - Country:US
Practice Address - Phone:773-234-8133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008233101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty