Healthcare Provider Details

I. General information

NPI: 1629605936
Provider Name (Legal Business Name): REBECCA LOPEZ PHD, LPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 05/19/2021
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 KATY FWY STE 910
HOUSTON TX
77079-2119
US

IV. Provider business mailing address

11111 KATY FWY STE 910
HOUSTON TX
77079-2119
US

V. Phone/Fax

Practice location:
  • Phone: 713-568-8253
  • Fax: 713-955-4982
Mailing address:
  • Phone: 713-568-8253
  • Fax: 713-955-4982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number34340
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number34340
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: