Healthcare Provider Details

I. General information

NPI: 1063785210
Provider Name (Legal Business Name): ANGELA LINA MEDELLIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 03/17/2024
Certification Date: 03/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 SCHERTZ PKWY STE 150
SCHERTZ TX
78154-1497
US

IV. Provider business mailing address

5700 SCHERTZ PKWY STE 150
SCHERTZ TX
78154-1497
US

V. Phone/Fax

Practice location:
  • Phone: 210-366-3700
  • Fax:
Mailing address:
  • Phone: 210-366-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number66166
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: