Provider Demographics
NPI:1508484460
Name:MARTINEZ, DANIEL JAMES (LCDC INTERN)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LCDC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8611 DATAPOINT DR APT 49
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3249
Mailing Address - Country:US
Mailing Address - Phone:512-962-7577
Mailing Address - Fax:
Practice Address - Street 1:5121 CRESTWAY RD STE 200B
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78239-1975
Practice Address - Country:US
Practice Address - Phone:210-310-3864
Practice Address - Fax:210-310-3719
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47170101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)