Provider Demographics
NPI:1699421891
Name:LOPEZ, HANNAH MARIE
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:MARIE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 E STARR AVE UNIT 279
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-5055
Mailing Address - Country:US
Mailing Address - Phone:702-305-1641
Mailing Address - Fax:
Practice Address - Street 1:2821 W HORIZON RIDGE PKWY STE 130
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4429
Practice Address - Country:US
Practice Address - Phone:702-840-1182
Practice Address - Fax:702-436-2593
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician