Provider Demographics
NPI:1912113796
Name:LOPEZ, JUAN CARLOS (LMFT)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:CARLOS
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 NW 85TH CT
Mailing Address - Street 2:APT 12
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3826
Mailing Address - Country:US
Mailing Address - Phone:305-262-5785
Mailing Address - Fax:
Practice Address - Street 1:365 NW 85TH CT
Practice Address - Street 2:APT 12
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3826
Practice Address - Country:US
Practice Address - Phone:305-262-5785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2214106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health