Provider Demographics
NPI:1689912743
Name:MEDINA, ANGELA CECILIA (LPC-S)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:CECILIA
Last Name:MEDINA
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 KENTON HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-1534
Mailing Address - Country:US
Mailing Address - Phone:832-606-9506
Mailing Address - Fax:
Practice Address - Street 1:2607 KENTON HOLLOW LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-1534
Practice Address - Country:US
Practice Address - Phone:832-606-9506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65911101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX261QF0400XOtherFQHC TAXONOMY
TX1609848332OtherNPI NAVIGATION
TX1245556885OtherNPI DUNN
TX760442781OtherTIN EL CENTRO
TX1245556885OtherNPI DUNN
TX1609848332OtherNPI NAVIGATION
TX671838Medicare Oscar/Certification