Provider Demographics
NPI:1275424079
Name:MARTIN, ANASTASIA RACHELL
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:RACHELL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6930 LAKEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-3715
Mailing Address - Country:US
Mailing Address - Phone:972-342-1167
Mailing Address - Fax:
Practice Address - Street 1:6930 LAKEVIEW CIR
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-3715
Practice Address - Country:US
Practice Address - Phone:972-342-1167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty