MEDICARE: JACOB MARTINEZ LPC

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
1	101YM0800X	Mental Health Counselor	73340	TX

General Provider Information

NPI Number	:	1952845380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB MARTINEZ LPC

Provider Business Mailing Address
First Line	:	9205 W CENTER ST STE 200
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-4548
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9205 W CENTER ST STE 200
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-4548
Country	:	US
Telephone Number	:	469-452-9260
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2016
Last Update Date	:	06/11/2025

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Directions to “ JACOB MARTINEZ LPC” Practice Location

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