Individual
MRS. HAILEY NICOLE MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, LCPC
Contact information
Practice address
2705 E 17TH ST, AMMON, ID 83406-6601
(208) 346-7500
Mailing address
1979 GRANDVIEW AVE, POCATELLO, ID 83204-3655
(208) 241-0173
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-6402
ID
Other
Enumeration date
06/06/2017
Last updated
06/06/2017
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