Provider Demographics
NPI:1952845380
Name:MARTINEZ, JACOB (LPC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 ELDORADO PKWY STE 332
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6520
Mailing Address - Country:US
Mailing Address - Phone:469-452-9260
Mailing Address - Fax:
Practice Address - Street 1:6401 ELDORADO PKWY STE 332
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6520
Practice Address - Country:US
Practice Address - Phone:469-452-9260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-04
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health