Provider Demographics
NPI:1427755826
Name:MEDINA HURST, VALERIE (LCSW)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:MEDINA HURST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21319 GANTON DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5229
Mailing Address - Country:US
Mailing Address - Phone:703-674-9943
Mailing Address - Fax:
Practice Address - Street 1:1040 SAKELARES BLVD
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-3819
Practice Address - Country:US
Practice Address - Phone:505-867-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2023-01071041C0700X
TX653831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical