Provider Demographics
NPI:1669361275
Name:MEDRANO, ANGELA NIVON (LPCA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:NIVON
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:AGELA
Other - Middle Name:NIVON
Other - Last Name:MEDRANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 SHANARD RD
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2186
Mailing Address - Country:US
Mailing Address - Phone:210-850-8486
Mailing Address - Fax:
Practice Address - Street 1:1130 S BURR ST STE 200
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4586
Practice Address - Country:US
Practice Address - Phone:605-292-0361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-21089101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional