Provider Demographics
NPI:1104613819
Name:MEDEL, CARLA SUZETTE (LMHCA)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:SUZETTE
Last Name:MEDEL
Suffix:
Gender:
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-4420
Mailing Address - Country:US
Mailing Address - Phone:541-314-5393
Mailing Address - Fax:
Practice Address - Street 1:3900 S ZINTEL WAY
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-5017
Practice Address - Country:US
Practice Address - Phone:509-942-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61523326101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health