MEDICARE: VALERIE SUSANN MEDINA LMFT

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
1	106H00000X	Marriage & Family Therapist	MFT.0002559	CO
2	106H00000X	Marriage & Family Therapist	140511	CA

General Provider Information

NPI Number	:	1992363147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE SUSANN MEDINA LMFT

Provider Business Mailing Address
First Line	:	7932 BAYONET CIR APT D
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80902-4693
Country	:	US
Telephone Number	:	951-231-7299
Fax Number	:

Provider Business Practice Location Address
First Line	:	7932 BAYONET CIR APT D
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80902-4693
Country	:	US
Telephone Number	:	951-231-7299
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2019
Last Update Date	:	06/02/2024

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