Beth a. Medina, Ms, LMHC, PA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH6748 Issued in FL

Legal business name

BETH A. MEDINA, MS, LMHC, PA

Practice address

13241 Bartram Park Blvd
Ste. 301
Jacksonville, FL 32258-5212

Phone

(904) 268-1696

Fax

(844) 864-3674

NPI assigned

May 19, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Beth Ann Medina, LMHC

Title

Owner

Phone

(904) 268-1696

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555372800000",
    "number": "1033520481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13241 BARTRAM PARK BLVD",
            "address_2": "STE. 301",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585212",
            "telephone_number": "904-268-1696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13241 BARTRAM PARK BLVD",
            "address_2": "STE. 301",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585212",
            "telephone_number": "904-268-1696",
            "fax_number": "844-864-3674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETH A. MEDINA, MS, LMHC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-19",
        "last_updated": "2019-04-16",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-268-1696",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH6748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.