MEDICARE: ELENA LOPEZ FAVELA NACA PHD

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

General Provider Information

NPI Number	:	1730806209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA LOPEZ FAVELA NACA PHD

Provider Business Mailing Address
First Line	:	310 CLIFTON AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-3218
Country	:	US
Telephone Number	:	612-223-8899
Fax Number	:

Provider Business Practice Location Address
First Line	:	4622 OLIVER AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55412-1127
Country	:	US
Telephone Number	:	210-633-4360
Fax Number	:

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

Provider Enumeration Date	:	10/25/2022
Last Update Date	:	05/01/2026

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