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General NPI Number Information
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NPI Number | 1790199040
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Entity Type | Individual
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Provider Name | JESSICA MARTINEZ MA, LPC-S
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Gender | Female
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Dates
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Enumeration Date | 06/15/2014
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 8111 LYNDON B JOHNSON FWY STE 900
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City | DALLAS
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State | TX
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Zip | 75251-1322
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Country | US
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Telephone | 800-241-8716
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Fax | 469-972-0031
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Provider Business Mailing Address
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Address Line | 4490 NANCY LN
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-4528
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Country | US
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Telephone | 469-245-6069
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 69555
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License Number State | TX
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