Healthcare Provider Details

I. General information

NPI: 1134827256
Provider Name (Legal Business Name): GRISEL LOPEZ-ESCOBAR PHD, LMHC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 PLAZA REAL STE 275
BOCA RATON FL
33432-3999
US

IV. Provider business mailing address

433 PLAZA REAL STE 275
BOCA RATON FL
33432-3999
US

V. Phone/Fax

Practice location:
  • Phone: 561-270-5989
  • Fax:
Mailing address:
  • Phone: 561-270-5989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number20052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: