Provider Demographics
NPI:1548465487
Name:MARTINEZ, JUNE MARIE (MA, TLLP)
Entity type:Individual
Prefix:
First Name:JUNE
Middle Name:MARIE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MA, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7175 POST RD
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:MI
Mailing Address - Zip Code:49437-9704
Mailing Address - Country:US
Mailing Address - Phone:616-744-5100
Mailing Address - Fax:
Practice Address - Street 1:200 HOLTON RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-3349
Practice Address - Country:US
Practice Address - Phone:616-744-5100
Practice Address - Fax:616-744-5110
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013584106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist