Provider Demographics
NPI:1972948230
Name:MARTIN, KENYATTA MYKIA (LPC)
Entity Type:Individual
Prefix:MS
First Name:KENYATTA
Middle Name:MYKIA
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 1:18219 MOSSY CREEK LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-5072
Mailing Address - Country:US
Mailing Address - Phone:832-622-7763
Mailing Address - Fax:
Practice Address - Street 1:4606 FM 1960 RD W
Practice Address - Street 2:#146
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4600
Practice Address - Country:US
Practice Address - Phone:832-389-6498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65848101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional