Provider Demographics
NPI:1912235714
Name:LOPEZ, JOEL ISAAC (MA, PHD-ABD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:ISAAC
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MA, PHD-ABD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7009 W KIMBERLY WAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5759
Mailing Address - Country:US
Mailing Address - Phone:602-488-1172
Mailing Address - Fax:
Practice Address - Street 1:7009 W KIMBERLY WAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5759
Practice Address - Country:US
Practice Address - Phone:602-488-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC23654101YA0400X, 101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health