MEDICARE: MS. SANDRA MARTINEZ 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	66197	TX

General Provider Information

NPI Number	:	1629354626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA MARTINEZ LPC

Provider Business Mailing Address
First Line	:	317 TAMWORTH DR
Second Line	:
City	:	CASTLE HILLS
State	:	TX
Zip	:	78213-1942
Country	:	US
Telephone Number	:	512-639-2828
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 TAMWORTH DR
Second Line	:
City	:	CASTLE HILLS
State	:	TX
Zip	:	78213-1942
Country	:	US
Telephone Number	:	512-639-2828
Fax Number	:

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

Provider Enumeration Date	:	10/23/2011
Last Update Date	:	08/05/2015

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