Healthcare Provider Details

I. General information

NPI: 1366174435
Provider Name (Legal Business Name): CAROL MEDLIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N HOWARD ST STE W
SPOKANE WA
99201-0508
US

IV. Provider business mailing address

8208 WINTER FALLS TRL
HURST TX
76053-7449
US

V. Phone/Fax

Practice location:
  • Phone: 972-850-8196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61492686
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number92649
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: