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NPI Code Detail

MEDICARE: JENNIFER NICOLE MARTINEZ M.ED., LPC

MEDICARE:   JENNIFER NICOLE MARTINEZ  M.ED., 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
1101YP2500XProfessional Counselor65133TX

General Provider Information

NPI Number : 1992142293
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER NICOLE MARTINEZ M.ED., LPC
Provider Business Mailing Address
First Line : 333 LANDWYCK LN
Second Line :
City : FLOWER MOUND
State : TX
Zip : 75028-7144
Country : US
Telephone Number : 817-798-5828
Fax Number :
Provider Business Practice Location Address
First Line : 4686 BRISTOL TRACE TRL
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-6947
Country : US
Telephone Number : 817-300-9484
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2013
Last Update Date : 05/28/2013

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Directions to “ JENNIFER NICOLE MARTINEZ M.ED., LPC” Practice Location

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