Provider Demographics
NPI:1003277625
Name:MEDEL, WESTLIE GRACE
Entity type:Individual
Prefix:
First Name:WESTLIE
Middle Name:GRACE
Last Name:MEDEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WESTLIE
Other - Middle Name:GRACE
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 N ROBINSON DR
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:TX
Mailing Address - Zip Code:76706-5312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19019 STATE HIGHWAY 71 W
Practice Address - Street 2:
Practice Address - City:SPICEWOOD
Practice Address - State:TX
Practice Address - Zip Code:78669-6468
Practice Address - Country:US
Practice Address - Phone:512-646-9789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101Y00000XBehavioral Health & Social Service ProvidersCounselor