Provider Demographics
NPI:1447933023
Name:MEDINA-FUNES, IRENE (LMHC)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:MEDINA-FUNES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 DANZANTE DR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-8790
Mailing Address - Country:US
Mailing Address - Phone:505-504-3773
Mailing Address - Fax:
Practice Address - Street 1:1425 DANZANTE DR SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-8790
Practice Address - Country:US
Practice Address - Phone:505-504-3773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2023-0581101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health