=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346606886
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NELIDA MARTIN LPC-S
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2016
-----------------------------------------------------
Last Update Date | 12/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4601 BUFFALO GAP RD STE A2
-----------------------------------------------------
City | ABILENE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79606-3361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-704-2553
-----------------------------------------------------
Fax | 325-701-9944
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4601 BUFFALO GAP RD STE A2
-----------------------------------------------------
City | ABILENE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79606-3361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-704-2553
-----------------------------------------------------
Fax | 325-701-9944
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 18921
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------