Provider Demographics
NPI:1063756690
Name:LOPEZ, LISA PAULETTE (MS, LMHC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:PAULETTE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 EUBANK BLVD NE APT 27
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-6181
Mailing Address - Country:US
Mailing Address - Phone:505-410-0334
Mailing Address - Fax:
Practice Address - Street 1:5801 EUBANK BLVD NE APT 27
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-6181
Practice Address - Country:US
Practice Address - Phone:505-410-0334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0152071101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health