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General NPI Number Information
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NPI Number | 1992142293
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Entity Type | Individual
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Provider Name | JENNIFER NICOLE MARTINEZ M.ED., LPC
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Gender | Female
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Dates
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Enumeration Date | 05/28/2013
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 4686 BRISTOL TRACE TRL
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City | FORT WORTH
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State | TX
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Zip | 76244-6947
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Country | US
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Telephone | 817-300-9484
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Fax |
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Provider Business Mailing Address
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Address Line | 333 LANDWYCK LN
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City | FLOWER MOUND
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State | TX
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Zip | 75028-7144
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Country | US
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Telephone | 817-798-5828
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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 | 65133
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License Number State | TX
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