Provider Demographics
NPI:1841792876
Name:MEDINA, DEBRA LYNNE (LMHC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNNE
Last Name:MEDINA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8243 ROSE PETAL CT
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6964
Mailing Address - Country:US
Mailing Address - Phone:727-992-2545
Mailing Address - Fax:
Practice Address - Street 1:8243 ROSE PETAL CT
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6964
Practice Address - Country:US
Practice Address - Phone:727-992-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9829101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health