Healthcare Provider Details

I. General information

NPI: 1801989397
Provider Name (Legal Business Name): GELIANI R. LOPEZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5753 MIAMI LAKES DR. EAST
MIAMI LAKES FL
33015
US

IV. Provider business mailing address

330 SW 51 COURT
MIAMI FL
33134
US

V. Phone/Fax

Practice location:
  • Phone: 305-403-0006
  • Fax:
Mailing address:
  • Phone: 786-262-0346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 6878
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: