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General NPI Number Information
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NPI Number | 1902296270
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Entity Type | Individual
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Provider Name | MICHELLE RENEE MAGEE-LOPEZ LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/26/2015
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Last Update Date | 11/07/2019
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Provider Practice Location Address
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Address Line | 17326 EDWARDS RD # A135
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City | CERRITOS
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State | CA
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Zip | 90703
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Country | US
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Telephone | 562-222-5258
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Fax |
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Provider Business Mailing Address
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Address Line | P.O.BOX 592 340 EAST 1ST STREET
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City | TUSTIN
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State | CA
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Zip | 92781-9998
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Country | US
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Telephone | 323-767-4946
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 113683
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License Number State | CA
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