MEDICARE: GENEVIEVE B MARTINEZ MS, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	81221	TX

General Provider Information

NPI Number	:	1053059360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENEVIEVE B MARTINEZ MS, LPC

Provider Business Mailing Address
First Line	:	2043 W WOODLAWN AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-5320
Country	:	US
Telephone Number	:	210-412-6355
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 N LOOP 1604 E STE 106
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-1369
Country	:	US
Telephone Number	:	210-412-6355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2022
Last Update Date	:	05/25/2022

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