Provider Demographics
NPI:1790199040
Name:MARTINEZ, JESSICA (MA, LPC-S)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MA, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4490 NANCY LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-4528
Mailing Address - Country:US
Mailing Address - Phone:469-245-6069
Mailing Address - Fax:
Practice Address - Street 1:8111 LYNDON B JOHNSON FWY STE 900
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-1322
Practice Address - Country:US
Practice Address - Phone:800-241-8716
Practice Address - Fax:469-972-0031
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-15
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69555101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional