Basic Information
| Provider Information | |||||||||
| NPI: | 1215409446 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | KARLO | ||||||||
| MiddleName: | IVAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 W HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980324403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538569000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 515 W HARRISON ST STE 109 | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980324403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538569000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2018 | ||||||||
| LastUpdateDate: | 12/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CG60898202 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.