MEDICARE: ANTOINETTE MARIE MARTINEZ M.ED, 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	71350	TX
2	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295113827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE MARIE MARTINEZ M.ED, LPC

Provider Business Mailing Address
First Line	:	5510 ABRAMS RD STE 120
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-2099
Country	:	US
Telephone Number	:	214-208-7469
Fax Number	:	866-294-6406

Provider Business Practice Location Address
First Line	:	5510 ABRAMS RD STE 120
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-2099
Country	:	US
Telephone Number	:	214-208-7469
Fax Number	:	866-294-6406

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

Provider Enumeration Date	:	05/15/2015
Last Update Date	:	10/08/2024

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