Provider Demographics
NPI:1104657840
Name:LOPEZ, JASMINE NICOLE (LPC-A)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:NICOLE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9815 SAGEMOSS LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-4224
Mailing Address - Country:US
Mailing Address - Phone:713-320-3195
Mailing Address - Fax:
Practice Address - Street 1:2656 S LOOP W STE 430
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-5623
Practice Address - Country:US
Practice Address - Phone:713-320-3195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96080101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional