Healthcare Provider Details

I. General information

NPI: 1124412390
Provider Name (Legal Business Name): STEPHANIE MARIE LOPEZ LMFT, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE MEREDITH HHP, MT

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7986 DAGGET ST
SAN DIEGO CA
92111-2321
US

IV. Provider business mailing address

PO BOX 1076
LA MESA CA
91944-1076
US

V. Phone/Fax

Practice location:
  • Phone: 858-300-0460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15120
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number30485
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number30485
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number141797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: