Healthcare Provider Details

I. General information

NPI: 1023765567
Provider Name (Legal Business Name): ALYSON LOPEZ MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SE 2ND AVE
GRAND RAPIDS MN
55744-3615
US

IV. Provider business mailing address

215 SE 2ND AVE
GRAND RAPIDS MN
55744-3615
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-1274
  • Fax: 218-326-9787
Mailing address:
  • Phone: 218-326-1274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3221
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: