Provider Demographics
NPI:1861766826
Name:MARTINI, ELIZABETH M (MA, CRC, LPC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:M
Last Name:MARTINI
Suffix:
Gender:F
Credentials:MA, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-3646
Mailing Address - Country:US
Mailing Address - Phone:585-730-1926
Mailing Address - Fax:
Practice Address - Street 1:45 E LOUCKS ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6339
Practice Address - Country:US
Practice Address - Phone:585-730-1926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1255101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional