Provider Demographics
NPI:1295113827
Name:MARTINEZ, ANTOINETTE MARIE (MED, LPC)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:MARIE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 ABRAMS RD STE 120
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2099
Mailing Address - Country:US
Mailing Address - Phone:214-208-7469
Mailing Address - Fax:866-294-6406
Practice Address - Street 1:5510 ABRAMS RD STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2099
Practice Address - Country:US
Practice Address - Phone:214-208-7469
Practice Address - Fax:866-294-6406
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71350101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3501603Medicaid