Provider Demographics
NPI:1154451821
Name:MARTINEZ, EUNICE (LPC-S)
Entity type:Individual
Prefix:MRS
First Name:EUNICE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3532 HAZELTIME ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-1120
Mailing Address - Country:US
Mailing Address - Phone:915-479-3249
Mailing Address - Fax:915-503-1970
Practice Address - Street 1:9440 VISCOUNT BLVD STE 110
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925
Practice Address - Country:US
Practice Address - Phone:915-479-3249
Practice Address - Fax:915-503-1970
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14704104100000X
TX18115101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161304402Medicaid