Provider Demographics
NPI:1518430677
Name:MARTINEZ, GESSY (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:GESSY
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 BOEING DR UNIT 972414
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79997-0060
Mailing Address - Country:US
Mailing Address - Phone:915-213-4410
Mailing Address - Fax:
Practice Address - Street 1:5959 GATEWAY BLVD W STE 324
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-3317
Practice Address - Country:US
Practice Address - Phone:915-213-4410
Practice Address - Fax:210-617-7046
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14274101YA0400X
TX73052101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)