MEDICARE: MARY-BETH S MARTIN AP-RN

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	229068	TX

General Provider Information

NPI Number	:	1881601821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY-BETH S MARTIN AP-RN

Provider Business Mailing Address
First Line	:	6823 CYPRESSWOOD DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-7705
Country	:	US
Telephone Number	:	281-376-8006
Fax Number	:	281-376-8008

Provider Business Practice Location Address
First Line	:	725 BATESWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-5800
Country	:	US
Telephone Number	:	281-376-8006
Fax Number	:	281-376-8008

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/08/2007

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