Provider Demographics
NPI:1598815755
Name:MARTIN, GLORIA L (LPC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7502 GREENVILLE AVE.
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3812
Mailing Address - Country:US
Mailing Address - Phone:214-890-4047
Mailing Address - Fax:214-890-9295
Practice Address - Street 1:7502 GREENVILLE AVE.
Practice Address - Street 2:SUITE 500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3812
Practice Address - Country:US
Practice Address - Phone:214-890-4047
Practice Address - Fax:214-890-9295
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16868101YM0800X
TX004974042772106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist