Provider Demographics
NPI:1366500704
Name:MEDIN, ROBERT SCOTT (MFCC MV17473 MFT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:SCOTT
Last Name:MEDIN
Suffix:
Gender:M
Credentials:MFCC MV17473 MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6579 MILTON CT
Mailing Address - Street 2:
Mailing Address - City:MAGALIA
Mailing Address - State:CA
Mailing Address - Zip Code:95954
Mailing Address - Country:US
Mailing Address - Phone:530-873-4955
Mailing Address - Fax:530-895-6597
Practice Address - Street 1:260 COHASSET ROAD
Practice Address - Street 2:SUITE E
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-895-6650
Practice Address - Fax:530-895-6597
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMV17473103T00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist