Individual
ALICIA MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2323 W FRONT ST, TYLER, TX 75702-7704
(903) 597-1351
(903) 535-7386
Mailing address
2323 W FRONT ST, TYLER, TX 75702-7704
(903) 597-1351
(903) 535-7386
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
66883
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
66883
LPC
TX
Enumeration date
05/23/2012
Last updated
01/08/2013
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