Individual
JACQUELINE MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHP
Contact information
Practice address
907 N BLUFF RD, COLLINSVILLE, IL 62234-5816
(618) 345-9644
(618) 345-6577
Mailing address
603 WALLER AVE, SAINT LOUIS, MO 63125-1512
(314) 662-4752
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/08/2018
Last updated
05/08/2018
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