Healthcare Provider Details

I. General information

NPI: 1023443603
Provider Name (Legal Business Name): VICTORIA LOPEZ LMHCA, LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 E OLIVE ST UNIT 310
SEATTLE WA
98122-2715
US

IV. Provider business mailing address

1605 E OLIVE ST #310
SEATTLE WA
98122-2757
US

V. Phone/Fax

Practice location:
  • Phone: 206-261-6535
  • Fax:
Mailing address:
  • Phone: 206-261-6535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60543782
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00017259
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: