Provider Demographics
NPI:1194602144
Name:MARTINEZ, CARLOS ALFREDO (LPC-A)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALFREDO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E HIGHLAND MALL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3776
Mailing Address - Country:US
Mailing Address - Phone:512-458-2437
Mailing Address - Fax:
Practice Address - Street 1:104 E HIGHLAND MALL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3776
Practice Address - Country:US
Practice Address - Phone:512-458-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99762101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional