Provider Demographics
NPI:1245998855
Name:MEDINA, DENISE (LMFT 153668)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:MEDINA
Suffix:
Gender:
Credentials:LMFT 153668
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 S EASTERN AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-4033
Mailing Address - Country:US
Mailing Address - Phone:714-623-9171
Mailing Address - Fax:
Practice Address - Street 1:5800 S EASTERN AVE STE 500
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-4033
Practice Address - Country:US
Practice Address - Phone:714-623-9171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT153668106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist