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General NPI Number Information
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NPI Number | 1104657840
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Entity Type | Individual
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Provider Name | JASMINE NICOLE LOPEZ LPC-A
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Gender | Female
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Dates
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Enumeration Date | 08/13/2024
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 2656 S LOOP W STE 430
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City | HOUSTON
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State | TX
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Zip | 77054-5623
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Country | US
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Telephone | 713-320-3195
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Fax |
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Provider Business Mailing Address
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Address Line | 9815 SAGEMOSS LN
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City | HOUSTON
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State | TX
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Zip | 77089-4224
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Country | US
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Telephone | 713-320-3195
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 96080
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License Number State | TX
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