Healthcare Provider Details

I. General information

NPI: 1790606895
Provider Name (Legal Business Name): ALYSSA RAYLEEN ZAMORA LOPEZ AMFT, ACPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8945 W RUSSELL RD STE 110
LAS VEGAS NV
89148-1225
US

IV. Provider business mailing address

8945 W RUSSELL RD STE 110
LAS VEGAS NV
89148-1225
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-9294
  • Fax: 702-201-1793
Mailing address:
  • Phone: 702-476-9294
  • Fax: 702-201-1793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCI5806
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: