Most Relevant Information
Provider Data
| NPI Number: | 1003636226 |
| Provider Name: | GABRIELLE MEDINA MA |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | LPCC.0022446 |
Most Important Dates
| Enumeration Date: | 10/14/2024 |
| Last Updated: | 10/14/2024 |
Provider Practice Location
925 S BROADWAY STE 211
CORTEZ
CO
813214033
Practice Location Phone/Fax
| Phone: | 9705167049 |
| Fax: |
Provider Mailing Location
417 S CEDAR ST APT 31
CORTEZ
CO
813213463
Provider Mailing Phone/Fax
| Phone: | 9708216468 |
| Fax: |