Provider Demographics
NPI:1538361811
Name:ROMERO, MARTIN JAMES (LPC, NCC)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:JAMES
Last Name:ROMERO
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:BRO MARTY
Other - Middle Name:
Other - Last Name:ROMERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:1904 W PINHOOK RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-8310
Mailing Address - Country:US
Mailing Address - Phone:985-312-2525
Mailing Address - Fax:337-221-1425
Practice Address - Street 1:1904 W PINHOOK RD STE 105
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8310
Practice Address - Country:US
Practice Address - Phone:985-312-2525
Practice Address - Fax:887-835-5025
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALPC #4906101YP2500X, 101YP2500X, 101YP2500X
LALAC# 1064101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600887225Medicaid