Healthcare Provider Details

I. General information

NPI: 1154769602
Provider Name (Legal Business Name): JESSICA MARTINEZ M.S, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 N POST OAK RD STE 100
HOUSTON TX
77055-7236
US

IV. Provider business mailing address

815 LOST CREEK CIR
KATY TX
77450-3301
US

V. Phone/Fax

Practice location:
  • Phone: 713-686-9194
  • Fax: 713-686-9413
Mailing address:
  • Phone: 832-704-0435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number68961
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: