Healthcare Provider Details

I. General information

NPI: 1952115388
Provider Name (Legal Business Name): LOPEZ WELLNESS & PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 W BELL RD STE 2
PHOENIX AZ
85053-2748
US

IV. Provider business mailing address

4025 W BELL RD STE 2
PHOENIX AZ
85053-2748
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 TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOEL ISAAC LOPEZ
Title or Position: CEO
Credential: PHD-ABD, LPC
Phone: 602-488-1172