Provider Demographics
NPI:1376571299
Name:MARTIN, TAMMIE D (MED, LPC-S)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:D
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MED, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 FM 1626
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANCHACA
Mailing Address - State:TX
Mailing Address - Zip Code:78652-3553
Mailing Address - Country:US
Mailing Address - Phone:512-280-5315
Mailing Address - Fax:512-280-5316
Practice Address - Street 1:1715 FM 1626
Practice Address - Street 2:SUITE 102
Practice Address - City:MANCHACA
Practice Address - State:TX
Practice Address - Zip Code:78652-3553
Practice Address - Country:US
Practice Address - Phone:512-280-5315
Practice Address - Fax:512-280-5316
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13297101Y00000X, 101YM0800X, 106H00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1649753633OtherNPPES
TX1467921197OtherNPPES
TX1043511827OtherNPPES
TX1669946695OtherNPPES