Provider Demographics
NPI:1992712798
Name:MARTZ, JODI MARIE (LCPC)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:MARIE
Last Name:MARTZ
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:T-9 FORT MISSOULA
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7202
Mailing Address - Country:US
Mailing Address - Phone:406-532-8400
Mailing Address - Fax:
Practice Address - Street 1:106 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9224
Practice Address - Country:US
Practice Address - Phone:406-723-4033
Practice Address - Fax:406-782-4020
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT965101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000747240OtherBLUE CROSS-SHIELD OF MONTANA FOR CENTER FOR MENTAL HEALTH