Healthcare Provider Details

I. General information

NPI: 1962797407
Provider Name (Legal Business Name): TANYA PATRICIA LOPEZ CARCAMO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. TANYA PATRICIA LOPEZ

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 6183
MORENO VALLEY CA
92554-6183
US

IV. Provider business mailing address

PO BOX 6183
MORENO VALLEY CA
92554-6183
US

V. Phone/Fax

Practice location:
  • Phone: 951-314-6743
  • Fax:
Mailing address:
  • Phone: 951-314-6743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT87293
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT-INTERN67049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: