Individual
MICHELLE MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
6582 E MAIN ST, FARMINGTON, NM 87402-5122
(505) 947-9990
Mailing address
6582 E MAIN ST, FARMINGTON, NM 87402-5122
(505) 947-9990
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CTB-2022-0262
NM
Other
Enumeration date
07/12/2022
Last updated
07/12/2022
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