Provider Demographics
NPI:1952768525
Name:MARTIN, GREG STEVEN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:STEVEN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 W MLK JR BLVD # 148
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1231
Mailing Address - Country:US
Mailing Address - Phone:512-686-6012
Mailing Address - Fax:512-842-7227
Practice Address - Street 1:821 W 11TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2009
Practice Address - Country:US
Practice Address - Phone:512-686-6012
Practice Address - Fax:512-842-7227
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71478101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional