Provider Demographics
NPI:1144927039
Name:MARTINEZ, JOSHUA SHANE (LCDC-I, MHPS, CHW)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:SHANE
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LCDC-I, MHPS, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 JUDSON RD STE 150
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5120
Mailing Address - Country:US
Mailing Address - Phone:903-234-8755
Mailing Address - Fax:903-234-8776
Practice Address - Street 1:1125 JUDSON RD STE 150
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5120
Practice Address - Country:US
Practice Address - Phone:903-234-8755
Practice Address - Fax:903-234-8776
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9822172V00000X
TX50044-1120175T00000X
TX1197-0120175T00000X
TX1814-0519175T00000X
TX54451101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist