Provider Demographics
NPI:1346606886
Name:MARTIN, NELIDA (LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:NELIDA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:MRS
Other - First Name:NELLIE
Other - Middle Name:MARTIN
Other - Last Name:TILLMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4601 BUFFALO GAP RD STE A2
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-3361
Mailing Address - Country:US
Mailing Address - Phone:325-704-2553
Mailing Address - Fax:325-701-9944
Practice Address - Street 1:4601 BUFFALO GAP RD STE A2
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-3361
Practice Address - Country:US
Practice Address - Phone:325-704-2553
Practice Address - Fax:325-701-9944
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13682575OtherCAQH