Provider Demographics
NPI:1295103158
Name:MARTINEZ, ANNIE BILLIE JEAN
Entity type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:BILLIE JEAN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANNIE
Other - Middle Name:BILLIE JEAN
Other - Last Name:JONES MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15945 SE MILL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-3663
Mailing Address - Country:US
Mailing Address - Phone:503-572-7089
Mailing Address - Fax:503-239-6233
Practice Address - Street 1:200 SE 7TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1200
Practice Address - Country:US
Practice Address - Phone:503-235-0131
Practice Address - Fax:503-239-7390
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCADCI18-P-10101Y00000X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No175T00000XOther Service ProvidersPeer Specialist