MEDICARE: ANGELA MARTILIK 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	61514	TX

General Provider Information

NPI Number	:	1801103064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARTILIK LPC

Provider Business Mailing Address
First Line	:	3131 TURTLE CREEK BLVD., #1026
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-5405
Country	:	US
Telephone Number	:	469-363-6264
Fax Number	:	214-522-2507

Provider Business Practice Location Address
First Line	:	3131 TURTLE CREEK BLVD., #1026
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-5405
Country	:	US
Telephone Number	:	469-363-6264
Fax Number	:	214-522-2507

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

Provider Enumeration Date	:	09/09/2010
Last Update Date	:	09/09/2010

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Directions to “ ANGELA MARTILIK LPC” Practice Location

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