Healthcare Provider Details

I. General information

NPI: 1982967907
Provider Name (Legal Business Name): VERONICA E MARTINEZ LPC,NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 KEATING DR
BELLE CHASSE LA
70037-1629
US

IV. Provider business mailing address

115 KEATING DR
BELLE CHASSE LA
70037-1629
US

V. Phone/Fax

Practice location:
  • Phone: 504-393-5750
  • Fax: 504-393-5760
Mailing address:
  • Phone: 504-393-5750
  • Fax: 504-393-5760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4440
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: