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General NPI Number Information
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NPI Number | 1942965322
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Entity Type | Individual
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Provider Name | DANIELLE MEDINA LPC
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Gender | Female
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 307 RIDGE ST STE 102
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City | TONGANOXIE
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State | KS
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Zip | 66086-9310
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Country | US
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Telephone | 913-845-6122
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Fax |
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Provider Business Mailing Address
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Address Line | 1199 RIDGE CIR APT A
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City | TONGANOXIE
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State | KS
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Zip | 66086-9317
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Country | US
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Telephone | 870-279-1104
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC03940-T
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 3992621634
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 5651054
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License Number State | AR
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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 | LPC04030
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License Number State | KS
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