Provider Demographics
NPI:1447651781
Name:MEDINA-SCHRAM, NANCY (MFTI)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:MEDINA-SCHRAM
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 NOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-3831
Mailing Address - Country:US
Mailing Address - Phone:626-806-9022
Mailing Address - Fax:
Practice Address - Street 1:2120 NOWELL AVE
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-3831
Practice Address - Country:US
Practice Address - Phone:626-806-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF67963101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAIMF67963OtherBOARD OF BEHAVIORAL SCIENCES LICENSE