Provider Demographics
NPI:1528654084
Name:LOPEZ, JONEISHA L (MA, LPC)
Entity type:Individual
Prefix:
First Name:JONEISHA
Middle Name:L
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:JONEISHA
Other - Middle Name:L
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:1213 E 43RD ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-5609
Mailing Address - Country:US
Mailing Address - Phone:432-279-0584
Mailing Address - Fax:
Practice Address - Street 1:1213 E 43RD ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-5609
Practice Address - Country:US
Practice Address - Phone:432-279-0584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72936101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional