Provider Demographics
NPI:1891703450
Name:MARTINDALE, JOHN RICHARD JR (MED, LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RICHARD
Last Name:MARTINDALE
Suffix:JR
Gender:M
Credentials:MED, LPC
Other - Prefix:MR
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:MARTINDALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:1331 ECHO MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-5310
Mailing Address - Country:US
Mailing Address - Phone:830-885-5805
Mailing Address - Fax:830-885-5805
Practice Address - Street 1:1278 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3442
Practice Address - Country:US
Practice Address - Phone:830-624-0248
Practice Address - Fax:830-608-0215
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18853101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164270404OtherTPI (TEXAS PROVIDER ID)
TX164270401Medicaid
TX164270404Medicaid
TX7259LCOtherBLUE CROSS/BLUE SHIELD #
TX7259LCOtherBLUE CROSS/BLUE SHIELD #