Provider Demographics
NPI:1275662249
Name:MEDINA, EMELY (LMFT)
Entity type:Individual
Prefix:MRS
First Name:EMELY
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:EMELY
Other - Middle Name:
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:2973 HARBOR BLVD
Mailing Address - Street 2:#227
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:626-533-8244
Mailing Address - Fax:
Practice Address - Street 1:2973 HARBOR BLVD
Practice Address - Street 2:#227
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626
Practice Address - Country:US
Practice Address - Phone:626-533-8244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CALMFT-77694106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist