=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083328025
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOPEZ BEHAVIORAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2023
-----------------------------------------------------
Last Update Date | 11/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 N LEE TREVINO DR STE B4
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79936-5164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-312-2868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1605 GEORGE DIETER DR STE 636
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79936-5600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-671-1371
-----------------------------------------------------
Fax | 915-219-9022
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JASMINE LOPEZ
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 915-312-2868
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------