Provider Demographics
NPI:1548970965
Name:MEDINA, JEHU SR (LMSW)
Entity type:Individual
Prefix:MR
First Name:JEHU
Middle Name:
Last Name:MEDINA
Suffix:SR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 S RURAL RD APT 130
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5427
Mailing Address - Country:US
Mailing Address - Phone:928-254-8194
Mailing Address - Fax:
Practice Address - Street 1:3409 S RURAL RD APT 130
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5427
Practice Address - Country:US
Practice Address - Phone:928-254-8194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health