Provider Demographics
NPI:1700219672
Name:MEDLEY, TICILY (PHD, LMFT-S)
Entity Type:Individual
Prefix:MS
First Name:TICILY
Middle Name:
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:PHD, LMFT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9659 N SAM HOUSTON PKWY E STE 150 # 113
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396
Mailing Address - Country:US
Mailing Address - Phone:972-454-9304
Mailing Address - Fax:
Practice Address - Street 1:3811 AMBER ROSE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77039-3349
Practice Address - Country:US
Practice Address - Phone:972-454-9304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65893101YP2500X
CO0002496106H00000X
TX201021106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional