Provider Demographics
NPI:1861220881
Name:MARTINEZ, EDGAR (MS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 E GRIFFIN PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3103
Mailing Address - Country:US
Mailing Address - Phone:956-648-8967
Mailing Address - Fax:956-600-7166
Practice Address - Street 1:1723 E GRIFFIN PKWY STE B
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3103
Practice Address - Country:US
Practice Address - Phone:956-648-8967
Practice Address - Fax:956-600-7166
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87995101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional