Jessica Sue Medina, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

21791 Issued in CO

Practice address

100 Kendall Dr
Lamar, CO 81052-3901

Phone

(719) 384-5446

Fax

(719) 336-7453

NPI assigned

Mar 18, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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": "1710720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1649039819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 MARKET ST",
            "city": "ALAMOSA",
            "state": "CO",
            "postal_code": "811012290",
            "telephone_number": "719-587-1060",
            "fax_number": "719-587-1525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 KENDALL DR",
            "city": "LAMAR",
            "state": "CO",
            "postal_code": "810523901",
            "telephone_number": "719-384-5446",
            "fax_number": "719-336-7453"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "711 Barnes Ave",
            "address_purpose": "LOCATION",
            "city": "LA Junta",
            "state": "CO",
            "postal_code": "810502138",
            "country_code": "US",
            "telephone_number": "719-384-5446",
            "fax_number": "866-220-5081",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "JESSICA",
        "middle_name": "SUE",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-18",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "21791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kent Allen Madsen, P.T.
• Larry Marez
• Melanie L Marshall, D.O.
• Katherine McCorkle, CAS
• Patrick Kevin McGrath, O.D.
• Keith Irvin Messersmith, D.D.S,
• Brian Scott Michaud, D.O.
• Louise None Middaugh, P.A.
• Jessica Anne Mitchell, M.A.
• Derrick Blane Monson, PTA

• Professional Counselor in Lamar, CO
• Providers in Lamar, CO by specialty
• Professional Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.