Provider Demographics
NPI:1760365654
Name:MARTIN, KARLOS ERIC (CERTIFIED PEER SUPT)
Entity type:Individual
Prefix:MR
First Name:KARLOS
Middle Name:ERIC
Last Name:MARTIN
Suffix:
Gender:M
Credentials:CERTIFIED PEER SUPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 S 500 W STE 103
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-6654
Mailing Address - Country:US
Mailing Address - Phone:888-332-6125
Mailing Address - Fax:888-347-2592
Practice Address - Street 1:9500 S 500 W STE 103
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-6654
Practice Address - Country:US
Practice Address - Phone:888-332-6125
Practice Address - Fax:888-332-2592
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AZ175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health