Provider Demographics
NPI:1225703549
Name:JENNIFER MARTINEZ CHILD AND ADOLESCENT COUNSELING PLLC
Entity Type:Organization
Organization Name:JENNIFER MARTINEZ CHILD AND ADOLESCENT COUNSELING PLLC
Other - Org Name:MONARCH CHILD AND ADOLESCENT COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:512-765-5157
Mailing Address - Street 1:1464 E WHITESTONE BLVD STE 2201
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-9080
Mailing Address - Country:US
Mailing Address - Phone:512-765-5157
Mailing Address - Fax:
Practice Address - Street 1:1464 E WHITESTONE BLVD STE 2201
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-9080
Practice Address - Country:US
Practice Address - Phone:512-765-5157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health