Provider Demographics
NPI:1992561682
Name:LOPEZ, LAURA (AMFT & APCC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:AMFT & APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 S YORKTOWN ST
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-5154
Mailing Address - Country:US
Mailing Address - Phone:760-793-2263
Mailing Address - Fax:
Practice Address - Street 1:1400 N NORMA ST STE 125
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-2577
Practice Address - Country:US
Practice Address - Phone:760-463-5044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15723101YP2500X
CA143769106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional