Healthcare Provider Details

I. General information

NPI: 1659094167
Provider Name (Legal Business Name): ABIGAIL LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 RIO GRANDE ST
AUSTIN TX
78701-1124
US

IV. Provider business mailing address

1700 RIO GRANDE ST STE 200
AUSTIN TX
78701-1638
US

V. Phone/Fax

Practice location:
  • Phone: 512-732-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number86802
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: