MEDICARE: ALEJANDRO EFRAIN LOPEZ JR. M.A, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	77229	TX

General Provider Information

NPI Number	:	1700348638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEJANDRO EFRAIN LOPEZ JR. M.A, LPC

Provider Business Mailing Address
First Line	:	8310 TIMBER BOUGH ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78250-4436
Country	:	US
Telephone Number	:	210-724-7880
Fax Number	:

Provider Business Practice Location Address
First Line	:	8310 TIMBER BOUGH ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78250-4436
Country	:	US
Telephone Number	:	210-724-7880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2019
Last Update Date	:	06/11/2024

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