Healthcare Provider Details

I. General information

NPI: 1568304558
Provider Name (Legal Business Name): JUAN JOSE MARTINEZ JR. LPC ASSOCIATE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 N. 9TH ST.
CARRIZO SPRINGS TX
78834
US

IV. Provider business mailing address

1819 N. 9TH ST.
CARRIZO SPRINGS TX
78834
US

V. Phone/Fax

Practice location:
  • Phone: 830-876-2611
  • Fax: 830-876-3776
Mailing address:
  • Phone: 830-876-2611
  • Fax: 830-876-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number92621
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: