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NPI Code Detail

MEDICARE: MRS. TONI LYNN MARTINEZ BS, LCDC

MEDICARE: MRS. TONI LYNN MARTINEZ BS, LCDC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor12200TX

General Provider Information

NPI Number : 1285027706
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TONI LYNN MARTINEZ BS, LCDC
Provider Business Mailing Address
First Line : PO BOX 1
Second Line :
City : BLANCO
State : TX
Zip : 78606-0001
Country : US
Telephone Number : 830-385-4712
Fax Number : 210-299-4595
Provider Business Practice Location Address
First Line : 519 E QUINCY ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78215-1605
Country : US
Telephone Number : 830-385-4712
Fax Number : 210-299-4595
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2015
Last Update Date : 03/09/2015

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