Healthcare Provider Details

I. General information

NPI: 1386158715
Provider Name (Legal Business Name): MAYRA LOPEZ LPCC20612
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAYRA ZARAGOZA

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 COALINGA PLZ
COALINGA CA
93210-1704
US

IV. Provider business mailing address

380 COALINGA PLZ
COALINGA CA
93210-1704
US

V. Phone/Fax

Practice location:
  • Phone: 855-343-1057
  • Fax: 844-563-6078
Mailing address:
  • Phone: 855-343-1057
  • Fax: 844-587-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC20612
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: