Healthcare Provider Details

I. General information

NPI: 1912235714
Provider Name (Legal Business Name): JOEL ISAAC LOPEZ M.A., PHD-ABD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7009 W KIMBERLY WAY
GLENDALE AZ
85308-5759
US

IV. Provider business mailing address

7009 W KIMBERLY WAY
GLENDALE AZ
85308-5759
US

V. Phone/Fax

Practice location:
  • Phone: 602-488-1172
  • Fax:
Mailing address:
  • Phone: 602-488-1172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC23654
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLPC23654
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC23654
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: