Provider Demographics
NPI:1629387816
Name:MARTINEZ, STACY ANN (LPC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 E ROBERTSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-3859
Mailing Address - Country:US
Mailing Address - Phone:956-245-7210
Mailing Address - Fax:
Practice Address - Street 1:175 E ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-3859
Practice Address - Country:US
Practice Address - Phone:956-245-7210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65020101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX65020OtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES