Provider Demographics
NPI:1053734129
Name:MARTINEZ, RAYMOND PERALES (LPC)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:PERALES
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:3919 BELLE MERE ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-6704
Mailing Address - Country:US
Mailing Address - Phone:936-615-1481
Mailing Address - Fax:
Practice Address - Street 1:3919 BELLE MERE ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-6704
Practice Address - Country:US
Practice Address - Phone:936-615-1481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68832101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor