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General NPI Number Information
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NPI Number | 1396528949
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Entity Type | Individual
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Provider Name | LAUREN BOETA-LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 8348 LINCOLN AVE
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City | SKOKIE
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State | IL
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Zip | 60077-2436
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Country | US
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Telephone | 312-298-9402
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 FAIRWAY DR
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City | EDINBURG
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State | TX
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Zip | 78539-5445
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Country | US
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Telephone | 773-414-3483
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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 | 89396
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178018543
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License Number State | IL
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