Provider Demographics
NPI:1144930868
Name:MARTINEZ, JON SEBASTIAN
Entity type:Individual
Prefix:
First Name:JON
Middle Name:SEBASTIAN
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1686 BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-2937
Mailing Address - Country:US
Mailing Address - Phone:956-206-1130
Mailing Address - Fax:
Practice Address - Street 1:610 N BROADWAY
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3426
Practice Address - Country:US
Practice Address - Phone:956-206-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11318125101YM0800X
TX87416101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health