Provider Demographics
NPI:1962790675
Name:MARTIN-JACKSON, LATOYA C (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:LATOYA
Middle Name:C
Last Name:MARTIN-JACKSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
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Mailing Address - Street 1:19123 DAWNTREADER DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4323
Mailing Address - Country:US
Mailing Address - Phone:281-746-2704
Mailing Address - Fax:832-413-5072
Practice Address - Street 1:8300 FM 1960 RD W
Practice Address - Street 2:SUITE 450
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5654
Practice Address - Country:US
Practice Address - Phone:281-746-2704
Practice Address - Fax:832-413-5072
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX66427101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287170902Medicaid