Healthcare Provider Details

I. General information

NPI: 1528929759
Provider Name (Legal Business Name): EMILIANO LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N COUNTY FARM RD
WHEATON IL
60187-3988
US

IV. Provider business mailing address

411 GRACE ST
BENSENVILLE IL
60106-2610
US

V. Phone/Fax

Practice location:
  • Phone: 630-744-9410
  • Fax:
Mailing address:
  • Phone: 630-744-9410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number003388
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: