Provider Demographics
NPI:1487360319
Name:MERCADO MARTINEZ COUNSELING A MARRIAGE AND FAMILY THERAPY CORPOR
Entity type:Organization
Organization Name:MERCADO MARTINEZ COUNSELING A MARRIAGE AND FAMILY THERAPY CORPOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCADO MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-364-2558
Mailing Address - Street 1:36068 HIDDEN SPRINGS RD STE C1023
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7679
Mailing Address - Country:US
Mailing Address - Phone:951-364-2558
Mailing Address - Fax:
Practice Address - Street 1:36068 HIDDEN SPRINGS RD STE C1023
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7679
Practice Address - Country:US
Practice Address - Phone:951-852-2016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty