Provider Demographics
NPI:1407652456
Name:MEDINA, ELVA M (LPC)
Entity type:Individual
Prefix:
First Name:ELVA
Middle Name:M
Last Name:MEDINA
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20931 W 123RD TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-6422
Mailing Address - Country:US
Mailing Address - Phone:785-250-2809
Mailing Address - Fax:
Practice Address - Street 1:20931 W 123RD TER
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-6422
Practice Address - Country:US
Practice Address - Phone:785-250-2809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04981101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional