Chandra Medina, Marriage and Family Therapy Inc

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

CHANDRA MEDINA, MARRIAGE AND FAMILY THERAPY INC

Practice address

22792 Centre Dr Ste 104
Lake Forest, CA 92630-6311

Phone

(714) 326-3722

NPI assigned

Aug 23, 2024

Organization subpart

No

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

Authorized official

Name

Chandra Medina, LMFTNPI 1316218852

Title

President/Owner

Phone

(714) 326-3722

Specialties & licenses 1

Addresses

Other names 1

• Thrive Recovery Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Chandra Medina

  • Mental Health Counselor
  • Sacramento, CA
  • NPI 1316218852

  Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1724371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724630400000",
    "number": "1467285478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22792 CENTRE DR STE 104",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926306311",
            "telephone_number": "714-326-3722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22792 CENTRE DR STE 104",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926306311",
            "telephone_number": "714-326-3722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANDRA MEDINA, MARRIAGE AND FAMILY THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-23",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "CHANDRA",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "714-326-3722",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Thrive Recovery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary M Chalaby
• Alexandrea Chambers
• Victoria Chambers
• Champion Health & Wellness Functional Nursing, P.C.
• Gertrude Chancellor, FNP-BC
• Diem Chieu Chang, D.D.S.
• Eileen M Chang, LMFT
• Grace Chang, M.D., PH.D.
• Ku-Juey Raymond Chang, M.D.
• Shirley Chang, DPM

• All providers in Lake Forest, CA
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; 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.