Provider Demographics
NPI:1861893943
Name:MARTINO, MICHAEL (LPC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MARTINO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 HEBRON PKWY
Mailing Address - Street 2:1102
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5151
Mailing Address - Country:US
Mailing Address - Phone:940-368-3285
Mailing Address - Fax:
Practice Address - Street 1:860 HEBRON PKWY
Practice Address - Street 2:1102
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5151
Practice Address - Country:US
Practice Address - Phone:940-368-3285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70109101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional