Provider Demographics
NPI:1053059360
Name:MARTINEZ, GENEVIEVE B (MS, LPC)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:B
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2043 W WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-5320
Mailing Address - Country:US
Mailing Address - Phone:210-412-6355
Mailing Address - Fax:
Practice Address - Street 1:1350 N LOOP 1604 E STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1369
Practice Address - Country:US
Practice Address - Phone:210-412-6355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81221101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health