Provider Demographics
NPI:1396147617
Name:MARTINEZ, NOLAN ADOLFO (MA, LPC INTERN)
Entity type:Individual
Prefix:
First Name:NOLAN
Middle Name:ADOLFO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MA, LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19115 FM 2252
Mailing Address - Street 2:SUITE 12
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78266-2577
Mailing Address - Country:US
Mailing Address - Phone:210-309-2006
Mailing Address - Fax:210-545-2504
Practice Address - Street 1:19115 FM 2252
Practice Address - Street 2:SUITE 12
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78266-2577
Practice Address - Country:US
Practice Address - Phone:210-309-2006
Practice Address - Fax:210-545-2504
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72531101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional