Provider Demographics
NPI:1639656598
Name:MARTIN, PAUL ANDREW (LPC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ANDREW
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10109 LAKE CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-1711
Mailing Address - Country:US
Mailing Address - Phone:512-758-5673
Mailing Address - Fax:
Practice Address - Street 1:5808 BALCONES DR STE 201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4215
Practice Address - Country:US
Practice Address - Phone:512-980-3251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73619101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional