Healthcare Provider Details

I. General information

NPI: 1417360843
Provider Name (Legal Business Name): ANNA LOPEZ LPCC, PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N CAMPO ST
LAS CRUCES NM
88001-3433
US

IV. Provider business mailing address

330 N CAMPO ST
LAS CRUCES NM
88001-3433
US

V. Phone/Fax

Practice location:
  • Phone: 575-650-0853
  • Fax:
Mailing address:
  • Phone: 575-650-0853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0166021
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: