Provider Demographics
NPI:1619076668
Name:MARTINEZ, RUBEN PATRICIO (PHD LPC)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:PATRICIO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PHD LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 PEDDIE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-4437
Mailing Address - Country:US
Mailing Address - Phone:281-455-8100
Mailing Address - Fax:
Practice Address - Street 1:540 HEIGHTS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2552
Practice Address - Country:US
Practice Address - Phone:281-455-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2023-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10624101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX027473001Medicaid