Provider Demographics
NPI:1235352105
Name:MARTIN, JANUARY ELIZABETH (LCSW, LCDC)
Entity Type:Individual
Prefix:
First Name:JANUARY
Middle Name:ELIZABETH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 SOUTH MOPAC EXPWY
Mailing Address - Street 2:BUILDING 2, SUITE 103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735
Mailing Address - Country:US
Mailing Address - Phone:512-638-2682
Mailing Address - Fax:
Practice Address - Street 1:4425 SOUTH MOPAC EXPWY
Practice Address - Street 2:BUILDING 2, SUITE 103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-6710
Practice Address - Country:US
Practice Address - Phone:512-638-2682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11298101YA0400X
TX54107104100000X, 106H00000X
171M00000X
54107101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator