Individual provider Active NPI

Desirae Martinez, PLPC

  • Counselor
  • Saint Louis, MO
National Provider Identifier
1912767963
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
2024007349 Issued in MO
Practice address
11166 Tesson Ferry Rd Ste 300
Saint Louis, MO 63123-6966
Phone
(314) 898-0102
Fax
(314) 842-2552
NPI assigned
Mar 19, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 2024007349 MO Primary

Addresses

Primary practice location

11166 Tesson Ferry Rd Ste 300
Saint Louis, MO 63123-6966

Mailing address

2650 Olive St
Saint Louis, MO 63103-1489
Phone (314) 533-8200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260414000873 MO Practitioner - Mental Health Counselor 4385119775 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

66 E Flagler St
Miami, FL 33130-1807

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2024007349MOMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Provident Inc. CurrentSince Mar 24, 2024 Accepting new patients
Provident Inc PastSince Mar 24, 2024 Accepting new patients

Locations

2650 Olive St
Saint Louis, MO 63103
Phone (314) 371-6500

11166 Tesson Ferry Rd
Ste 300
Saint Louis, MO 63123
Phone (314) 802-2647

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1710806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1912767963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 OLIVE ST",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631031489",
            "telephone_number": "314-533-8200",
            "fax_number": "314-842-2552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11166 TESSON FERRY RD STE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631236966",
            "telephone_number": "314-898-0102",
            "fax_number": "314-842-2552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "DESIRAE",
        "credential": "PLPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-19",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MO",
            "license": "2024007349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.