Provider Demographics
NPI:1033688718
Name:MARTIN, SHARESE MCNEIL (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:SHARESE
Middle Name:MCNEIL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77410-0147
Mailing Address - Country:US
Mailing Address - Phone:281-382-1474
Mailing Address - Fax:281-547-8065
Practice Address - Street 1:9950 CYPRESSWOOD DR STE 224
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3413
Practice Address - Country:US
Practice Address - Phone:281-382-1474
Practice Address - Fax:281-547-8065
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-25
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77319101Y00000X, 101YM0800X, 101YP2500X
TX101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
14371575OtherCAQH