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General NPI Number Information
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NPI Number | 1033520481
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Entity Type | Organization
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Legal Business Name | BETH A. MEDINA, MS, LMHC, PA
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 04/16/2019
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Provider Practice Location Address
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Address Line | 13241 BARTRAM PARK BLVD STE. 301
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City | JACKSONVILLE
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State | FL
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Zip | 32258-5212
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Country | US
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Telephone | 904-268-1696
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Fax | 844-864-3674
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Provider Business Mailing Address
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Address Line | 13241 BARTRAM PARK BLVD STE. 301
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City | JACKSONVILLE
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State | FL
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Zip | 32258-5212
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Country | US
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Telephone | 904-268-1696
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. BETH ANN MEDINA
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Credential | LMHC
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Telephone | 904-268-1696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH6748
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License Number State | FL
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