Provider Demographics
NPI:1043229339
Name:ALANIZ, MARTHA ALICIA (LPC)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ALICIA
Last Name:ALANIZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:DR
Other - First Name:MARTHA
Other - Middle Name:ALICIA
Other - Last Name:ALANIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:17503 LA CANTERA PKWY
Mailing Address - Street 2:SUITE 104, BOX 509
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-8207
Mailing Address - Country:US
Mailing Address - Phone:956-266-2808
Mailing Address - Fax:210-614-4991
Practice Address - Street 1:17503 LA CANTERA PKWY
Practice Address - Street 2:SUITE 104, BOX 509
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-8207
Practice Address - Country:US
Practice Address - Phone:210-614-4990
Practice Address - Fax:210-614-4991
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19050101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167167901Medicaid