Provider Demographics
NPI:1588206411
Name:MEDINATHERAPY PLLC
Entity Type:Organization
Organization Name:MEDINATHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-708-7151
Mailing Address - Street 1:5900 S LAKE FOREST DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2238
Mailing Address - Country:US
Mailing Address - Phone:469-708-7151
Mailing Address - Fax:858-836-5708
Practice Address - Street 1:5900 S LAKE FOREST DR STE 300
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2238
Practice Address - Country:US
Practice Address - Phone:469-708-7151
Practice Address - Fax:858-836-5708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty