Provider Demographics
NPI:1508349523
Name:MEDINA, LYDIA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N WARE RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6616
Mailing Address - Country:US
Mailing Address - Phone:956-664-0057
Mailing Address - Fax:
Practice Address - Street 1:2009 N CONWAY AVE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2965
Practice Address - Country:US
Practice Address - Phone:956-821-7350
Practice Address - Fax:956-580-4804
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75762101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional