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General NPI Number Information
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NPI Number | 1609791888
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Entity Type | Individual
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Provider Name | ALYSIA PAVLENKO MEDINA LPC
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Gender | Female
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Dates
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Enumeration Date | 08/13/2026
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Last Update Date | 08/13/2026
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Provider Practice Location Address
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Address Line | 700 E OGDEN AVE STE 304
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City | WESTMONT
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State | IL
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Zip | 60559-5554
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Country | US
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Telephone | 512-368-6408
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Fax |
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Provider Business Mailing Address
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Address Line | 2 ELM CREEK DR APT 508
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City | ELMHURST
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State | IL
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Zip | 60126-5232
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Country | US
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Telephone | 512-368-6408
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 178022733
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License Number State | IL
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