Healthcare Provider Details

I. General information

NPI: 1093054165
Provider Name (Legal Business Name): ELIZABETH MARTINEZ ACUNA LPC LPCC NCC CCMHC D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BALCONES DR STE 100
AUSTIN TX
78731-4298
US

IV. Provider business mailing address

4641 FULTON DR NW
CANTON OH
44718-2384
US

V. Phone/Fax

Practice location:
  • Phone: 330-999-0317
  • Fax:
Mailing address:
  • Phone: 330-433-6075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC1200252
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1800848
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number80644
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: