Provider Demographics
NPI:1447430087
Name:MARTINEZ-CHINCHILLA, MARITZA (MSW, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARITZA
Middle Name:
Last Name:MARTINEZ-CHINCHILLA
Suffix:
Gender:F
Credentials:MSW, LPC
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 57892
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7892
Mailing Address - Country:US
Mailing Address - Phone:832-646-5691
Mailing Address - Fax:
Practice Address - Street 1:991 BUOY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-5119
Practice Address - Country:US
Practice Address - Phone:832-646-5691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7954101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXLP0006808Medicaid