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NPI Code Detail

MEDICARE: BRENDA BERENICE MEDINA, LPCC LPCC

MEDICARE: BRENDA BERENICE MEDINA, LPCC LPCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor0126261NM
2101YP2500XProfessional CounselorCCMH0159131NM

General Provider Information

NPI Number : 1952637803
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDA BERENICE MEDINA, LPCC LPCC
Provider Business Mailing Address
First Line : 4730 BECKNER RD
Second Line :
City : SANTA FE
State : NM
Zip : 87507-3691
Country : US
Telephone Number : 505-989-4500
Fax Number :
Provider Business Practice Location Address
First Line : 4730 BECKNER RD
Second Line :
City : SANTA FE
State : NM
Zip : 87507-3691
Country : US
Telephone Number : 505-989-4500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2009
Last Update Date : 01/22/2024

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