Individual provider Active NPI

Eduardo Medina Jr., LMHC

  • Mental Health Counselor
  • Tukwila, WA
National Provider Identifier
1487166146
Registry record updated Feb 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LH70022692 Issued in WA
Practice address
15455 65TH Ave S
Tukwila, WA 98188-2534
Phone
(206) 721-5170
Fax
(360) 353-9440
NPI assigned
Nov 2, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LH70022692 WA Primary

Addresses

Primary practice location

15455 65TH Ave S
Tukwila, WA 98188-2534

Mailing address

PO Box 2429
Longview, WA 98632-8486
Phone (360) 353-9494

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260213001472 TX Practitioner - Mental Health Counselor 8426538067 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cowlitz Indian TribeGroup PAC ID 8820030133, 26 clinicians

Practice addresses (Care Compare)

15455 65TH Ave S
Tukwila, WA 98188-2534
Phone (360) 575-3314

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LH70022692WAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Cowlitz Indian Tribe CurrentSince Jan 23, 2026 Accepting new patients
Cowlitz Indian Tribe CurrentSince Jan 23, 2026 Accepting new patients
Cowlitz Indian Tribe Addiction (Substance Use Disorder) Past Accepting new patients

Locations

1000 Davis Pl
DuPont, WA 98327
Phone (206) 721-5170

6450 Southcenter Blvd
Tukwila, WA 98188
Phone (206) 446-5410

15455 65th Ave S
Tukwila, WA 98188
Phone (206) 721-5170

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1509580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770076800000",
    "number": "1487166146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2429",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986328486",
            "telephone_number": "360-353-9494",
            "fax_number": "360-353-9440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15455 65TH AVE S",
            "city": "TUKWILA",
            "state": "WA",
            "postal_code": "981882534",
            "telephone_number": "206-721-5170",
            "fax_number": "360-353-9440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "EDUARDO",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-02",
        "last_updated": "2026-02-03",
        "certification_date": "2026-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LH70022692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tukwila, WA

Sources for this page

Verify at the official NPI Registry.