Mark Anthony Medina

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW60699712 Issued in WA

Practice address

1498 SE Tech Center PL
Vancouver, WA 98683-9591

Phone

(360) 567-2211

NPI assigned

Jul 8, 2013

Sex

Male

Sole proprietor

Yes

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)

Enrolled

State licenses

Practice roles

Locations

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.

• Real Life Community Behavioral Health PLLC

  • Mental Health Counselor
  • Vancouver, WA
  • NPI 1952063265
  NPD
• Catholic Community Services of Western Washington

  • Community/Behavioral Health Agency
  • Vancouver, WA
  • NPI 1558593350
  NPD (past)

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

{
    "created_epoch": "1373241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738540800000",
    "number": "1861833725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4105 E 16TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986616205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1498 SE TECH CENTER PL",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986839591",
            "telephone_number": "360-567-2211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "MARK",
        "middle_name": "ANTHONY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-08",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW60699712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda R Medeski-Nicacio, OD
• Nooshin-Nikki Nikki Medghalchy, LAC
• Medicare Hearing Co
• Medilogic LLC
• Cinthya Isabel Medina
• Natasha Marie Medina, MED., LMHC
• Paige Alayne Medina, MSN, RN, PMHNP-BC
• Trisha Rochelle Medina
• Medmarie & Family Homecare LLC
• Mednic PC

• Clinical Social Worker in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2025; 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.