Provider Demographics
NPI:1366249286
Name:MEDRANO, CAROLINA TORRES
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:TORRES
Last Name:MEDRANO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12935 W GLEN LOFTON
Mailing Address - Street 2:
Mailing Address - City:LYFORD
Mailing Address - State:TX
Mailing Address - Zip Code:78569
Mailing Address - Country:US
Mailing Address - Phone:956-966-9898
Mailing Address - Fax:
Practice Address - Street 1:12935 W GLEN LOFTON
Practice Address - Street 2:
Practice Address - City:LYFORD
Practice Address - State:TX
Practice Address - Zip Code:78569-7856
Practice Address - Country:US
Practice Address - Phone:956-966-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88648101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health