Individual
STACEY ANN MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
3350 W AMERICANA TER STE 210A, BOISE, ID 83706-2521
(986) 279-3252
Mailing address
PO BOX 6421, BOISE, ID 83707-6421
(986) 279-3252
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPC-8206
ID
101YP2500X
Professional Counselor
Primary
8331174
ID
Other
Enumeration date
07/29/2021
Last updated
12/09/2024
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