Provider Demographics
NPI:1396583274
Name:MEDINA MANI, KATYA
Entity type:Individual
Prefix:
First Name:KATYA
Middle Name:
Last Name:MEDINA MANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W MADRID AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-1734
Mailing Address - Country:US
Mailing Address - Phone:563-554-7441
Mailing Address - Fax:
Practice Address - Street 1:255 W MADRID AVE APT 5
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-1734
Practice Address - Country:US
Practice Address - Phone:563-554-7441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor