MEDICARE: JENNIFER MARTINEZ

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	101YP2500X	Professional Counselor	81595	TX

General Provider Information

NPI Number	:	1316513815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARTINEZ

Provider Business Mailing Address
First Line	:	406 HURSTSHIRE BND
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-0278
Country	:	US
Telephone Number	:	917-319-0477
Fax Number	:

Provider Business Practice Location Address
First Line	:	439 MASON PARK BLVD STE A
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-6242
Country	:	US
Telephone Number	:	832-819-1870
Fax Number	:

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

Provider Enumeration Date	:	06/03/2021
Last Update Date	:	06/03/2021

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Directions to “ JENNIFER MARTINEZ ” Practice Location

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