| Doctor Name: | JANUARY ELIZABETH MARTIN |
| NPI Number: | 1235352105 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMSW, LCDC |
| License Number: | 11298 |
| Business Practice Address: | 1715 Fm 1626 Ste 102 Suite 360 Manchaca, TX - 786523549 |
| Business Phone Number: | 5122805315 |
| Business Fax Number: | |
| Mailing Address: | 1715 Fm 1626 Ste 102, Suite 360 MANCHACA |
| State: | TX |
| Postal Code: | 786523549 |
| Phone Number: | 5122805315 |
| Fax Number: | |
| NPI Enumeration Date: | 04/10/2007 |
| NPI Last Update Date: | 04/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 11298 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |