Provider Demographics
NPI:1033565460
Name:MARTINEZ, OLGA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 S INTERSTATE 35
Mailing Address - Street 2:STE 103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-3865
Mailing Address - Country:US
Mailing Address - Phone:512-766-3627
Mailing Address - Fax:512-777-2801
Practice Address - Street 1:2211 S INTERSTATE 35
Practice Address - Street 2:STE 103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-3865
Practice Address - Country:US
Practice Address - Phone:512-766-3627
Practice Address - Fax:512-777-2801
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional