Provider Demographics
NPI:1891806527
Name:MARTINEZ, ANASTACIA (LPC)
Entity type:Individual
Prefix:
First Name:ANASTACIA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 GATEWAY BLVD WEST
Mailing Address - Street 2:SUITE 255
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925
Mailing Address - Country:US
Mailing Address - Phone:915-775-2599
Mailing Address - Fax:915-775-2584
Practice Address - Street 1:5959 GATEWAY BLVD WEST
Practice Address - Street 2:SUITE 255
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925
Practice Address - Country:US
Practice Address - Phone:915-775-2599
Practice Address - Fax:915-775-2584
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13618101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095678101Medicaid
TX3760LCOtherBCBS