Provider Demographics
NPI:1285027706
Name:MARTINEZ, TONI LYNN (BS, LCDC)
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:LYNN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:BS, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:BLANCO
Mailing Address - State:TX
Mailing Address - Zip Code:78606-0001
Mailing Address - Country:US
Mailing Address - Phone:830-385-4712
Mailing Address - Fax:210-299-4595
Practice Address - Street 1:519 E QUINCY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1605
Practice Address - Country:US
Practice Address - Phone:830-385-4712
Practice Address - Fax:210-299-4595
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)