Provider Demographics
NPI:1881005312
Name:MARTINEZ, CRISTY (LPC)
Entity Type:Individual
Prefix:
First Name:CRISTY
Middle Name:
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 1:7102 ALCOVE AVE APT 405
Mailing Address - Street 2:
Mailing Address - City:WOLFFORTH
Mailing Address - State:TX
Mailing Address - Zip Code:79382-9755
Mailing Address - Country:US
Mailing Address - Phone:806-781-8169
Mailing Address - Fax:
Practice Address - Street 1:4601 50TH ST STE 107A
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-3514
Practice Address - Country:US
Practice Address - Phone:806-553-6068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79545101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health