Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | IMH-20192 | FL |
N | 101YP1600X | Pastoral Counselor | LCC05-8975 | FL |
NPI | 1184153389 |
---|---|
Provider Name | Filiberto Arturo Medina |
First Address | Rockdale, TX 76567-6005 |
Second Address | Austin, TX 78744-6874 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2017 |
Last Update Date | 23/01/2021 |