Healthcare Provider Details

I. General information

NPI: 1194383968
Provider Name (Legal Business Name): SYLVIA MICHELLE LOPEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 DE ZAVALA RD
SAN ANTONIO TX
78249-2115
US

IV. Provider business mailing address

6333 DE ZAVALA RD
SAN ANTONIO TX
78249-2115
US

V. Phone/Fax

Practice location:
  • Phone: 210-399-4838
  • Fax: 210-877-9279
Mailing address:
  • Phone: 210-399-4838
  • Fax: 210-877-9279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number75019
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number75019
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: