Individual
STEPHANIE MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1539 MCHENRY AVE, MODESTO, CA 95350-4528
(209) 499-8407
Mailing address
1539 MCHENRY AVE, MODESTO, CA 95350-4528
(209) 702-0139
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
21352
CA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
94-2378380
—
CA
05
—
942378380
—
CA
Enumeration date
12/10/2018
Last updated
12/22/2025
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