Provider Demographics
NPI:1801129655
Name:MARTYN, MARYELLEN (MS LPC BCNCC BC-TMH)
Entity type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:
Last Name:MARTYN
Suffix:
Gender:F
Credentials:MS LPC BCNCC BC-TMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 RESEARCH FOREST DR STE 115-1183
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1504
Mailing Address - Country:US
Mailing Address - Phone:423-481-0881
Mailing Address - Fax:
Practice Address - Street 1:8000 RESEARCH FOREST DR STE 115-1183
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77382-1504
Practice Address - Country:US
Practice Address - Phone:423-481-0881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79898101YP2500X
CO5649101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional