Provider Demographics
NPI:1871745380
Name:MARTELL, JUSTIN LEE
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LEE
Last Name:MARTELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 PALMER ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-1412
Mailing Address - Country:US
Mailing Address - Phone:916-921-6099
Mailing Address - Fax:
Practice Address - Street 1:3131 PALMER ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-1412
Practice Address - Country:US
Practice Address - Phone:916-921-6099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health