MEDICARE: DR. LATOYA C MARTIN-JACKSON MA, LPCS

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	101YP2500X	Professional Counselor	66427	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962790675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LATOYA C MARTIN-JACKSON MA, LPCS

Provider Business Mailing Address
First Line	:	12238 QUEENSTON BLVD STE G
Second Line	:	SUITE G
City	:	HOUSTON
State	:	TX
Zip	:	77095-5351
Country	:	US
Telephone Number	:	281-746-2704
Fax Number	:	832-413-5072

Provider Business Practice Location Address
First Line	:	12238 QUEENSTON BLVD STE G
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-5351
Country	:	US
Telephone Number	:	281-746-2704
Fax Number	:	832-413-5072

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

Provider Enumeration Date	:	07/14/2011
Last Update Date	:	03/10/2026

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