Tanisha Medina, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LH60784954 Issued in WA

Practice address

6922 22ND St W Ste C
University Place, WA 98466-7600

Phone

(253) 414-6491

NPI assigned

Oct 15, 2015

Last updated

Jan 30, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Tanisha Medina Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1444867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548806400000",
    "number": "1548631500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6922 22ND ST W STE C",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984667600",
            "telephone_number": "253-414-6491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6922 22ND ST W STE C",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984667600",
            "telephone_number": "253-414-6491"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9330 59th Ave SW",
            "address_purpose": "LOCATION",
            "city": "Lakewood",
            "state": "WA",
            "postal_code": "984992858",
            "country_code": "US",
            "telephone_number": "253-620-5015",
            "fax_number": "253-620-5013",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "TANISHA",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-15",
        "last_updated": "2019-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MC60520063",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LH60784954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TANISHA",
            "last_name": "MEDINA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• McRae and Radonich Inc PS (Physical Therapy Associates INC PS)
• Georgia Ann McRae, PT
• Laura Christine Meader
• Medical Equilibrium LLC
• Amparo Medina-Perez, MSW
• Medtriq LLC
• Medtriq Treatment Center LLC
• Linda Kim Mendoza, DPT
• Iris Brown Meneghel, RN
• Gloriam Zaid Mercado-Justiniano

• Mental Health Counselor in University Place, WA
• Providers in University Place, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.