MEDICARE: JESSICA MARTINEZ MA, LPC-S

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	69555	TX

General Provider Information

NPI Number	:	1790199040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARTINEZ MA, LPC-S

Provider Business Mailing Address
First Line	:	4490 NANCY LN
Second Line	:
City	:	MIDLOTHIAN
State	:	TX
Zip	:	76065-4528
Country	:	US
Telephone Number	:	469-245-6069
Fax Number	:

Provider Business Practice Location Address
First Line	:	8111 LYNDON B JOHNSON FWY STE 900
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-1322
Country	:	US
Telephone Number	:	800-241-8716
Fax Number	:	469-972-0031

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

Provider Enumeration Date	:	06/15/2014
Last Update Date	:	10/24/2023

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