Provider Demographics
NPI:1528238292
Name:WESLEY, MARTIN CORTEZ (PHD, LPCC-S LMHC)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:CORTEZ
Last Name:WESLEY
Suffix:
Gender:M
Credentials:PHD, LPCC-S LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12201 CITRUS LEAF DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONTON
Mailing Address - State:FL
Mailing Address - Zip Code:33534-5630
Mailing Address - Country:US
Mailing Address - Phone:813-439-7676
Mailing Address - Fax:
Practice Address - Street 1:208 APOLLO BEACH BLVD STE 107
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2250
Practice Address - Country:US
Practice Address - Phone:813-439-7676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-09
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103169101Y00000X, 101YM0800X, 101YP2500X
FLMH17156101Y00000X, 101YM0800X, 101YP2500X
KY164838101YA0400X
KYKY-0665101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health