Provider Demographics
NPI:1265463582
Name:MARTIN, CAROLYN C (MS, LPC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:C
Last Name:MARTIN
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 1:5808 BALCONES DR STE 101
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4276
Mailing Address - Country:US
Mailing Address - Phone:512-919-2069
Mailing Address - Fax:
Practice Address - Street 1:5808 BALCONES DR STE 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4276
Practice Address - Country:US
Practice Address - Phone:512-919-2069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10422101YP2500X
TX175106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2014LCOtherBC/BS