Provider Demographics
NPI:1821232117
Name:MARTIN, ALYCE YVONNE (LPC)
Entity Type:Individual
Prefix:
First Name:ALYCE
Middle Name:YVONNE
Last Name: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:PO BOX 2666
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77902-2666
Mailing Address - Country:US
Mailing Address - Phone:361-575-8217
Mailing Address - Fax:361-575-6520
Practice Address - Street 1:120 DAVID WADE DRIVE
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77905
Practice Address - Country:US
Practice Address - Phone:361-575-8217
Practice Address - Fax:361-575-6520
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional