MEDICARE: MARYELLEN MARTYN MS LPC BCNCC BC-TMH

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	5649	CO
2	101YP2500X	Professional Counselor	79898	TX

General Provider Information

NPI Number	:	1801129655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYELLEN MARTYN MS LPC BCNCC BC-TMH

Provider Business Mailing Address
First Line	:	619 W MAIN ST STE 1005
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375-5500
Country	:	US
Telephone Number	:	423-481-0881
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 W MAIN ST STE 1005
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375-5500
Country	:	US
Telephone Number	:	423-481-0881
Fax Number	:

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

Provider Enumeration Date	:	09/11/2009
Last Update Date	:	04/09/2026

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