Provider Demographics
NPI:1437893914
Name:MEDINA, ALLYSON M (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:M
Last Name:MEDINA
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LMFT
Mailing Address - Street 1:122 SHADYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7334
Mailing Address - Country:US
Mailing Address - Phone:713-562-8644
Mailing Address - Fax:
Practice Address - Street 1:122 SHADYWOOD LN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7334
Practice Address - Country:US
Practice Address - Phone:713-562-8644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201948106H00000X
TX68208101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist