Provider Demographics
NPI:1699833889
Name:SAN MARTIN, MICHELE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:SAN MARTIN
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 1:13112 HUNTERS LEDGE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2046
Mailing Address - Country:US
Mailing Address - Phone:210-854-6586
Mailing Address - Fax:
Practice Address - Street 1:2002 NW MILITARY HWY BLDG A-B, SUITE 13
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2148
Practice Address - Country:US
Practice Address - Phone:210-854-6586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60473101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182408802Medicaid