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General NPI Number Information
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NPI Number | 1134500416
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Entity Type | Organization
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Legal Business Name | MEDINA COUNSELING GROUP
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Dates
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Enumeration Date | 06/12/2015
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Last Update Date | 06/12/2015
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Provider Practice Location Address
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Address Line | 1600 AIRPORT FWY STE. 318
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City | BEDFORD
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State | TX
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Zip | 76022-6850
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Country | US
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Telephone | 214-274-5783
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Fax |
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Provider Business Mailing Address
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Address Line | 13601 PRESTON RD STE. WEST 520
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City | DALLAS
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State | TX
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Zip | 75240-4911
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Country | US
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Telephone | 214-274-5783
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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. MARGARITA YURI MEDINA
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Credential | LPC-S
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Telephone | 214-274-5783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 14907
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 14907
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 14907
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 14907
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License Number State | TX
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