Provider Demographics
NPI:1992846778
Name:DIAL, MARTHA SUE (LPC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:SUE
Last Name:DIAL
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 LONGSFORD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1817
Mailing Address - Country:US
Mailing Address - Phone:210-826-3215
Mailing Address - Fax:
Practice Address - Street 1:825 E BASSE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1832
Practice Address - Country:US
Practice Address - Phone:210-826-3215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3653106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11560OtherMARRIAGE & FAMILY THERAPI
TX3653OtherPROFESSIONAL COUNSELOR