Provider Demographics
NPI:1629011879
Name:MUNCH, MARTHA (LPC)
Entity type:Individual
Prefix:MISS
First Name:MARTHA
Middle Name:
Last Name:MUNCH
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 1:12500 NW MILITARY HWY # 250
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1897
Mailing Address - Country:US
Mailing Address - Phone:210-302-6920
Mailing Address - Fax:
Practice Address - Street 1:12500 NW MILITARY HWY # 250
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1897
Practice Address - Country:US
Practice Address - Phone:210-302-6920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19471101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174026801Medicaid