MEDICARE: VICTORIA LOPEZ LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	81712	TX

General Provider Information

NPI Number	:	1013644715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA LOPEZ LPC

Provider Business Mailing Address
First Line	:	505 PECAN ST STE 102
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-4079
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 PECAN ST STE 102
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-4079
Country	:	US
Telephone Number	:	817-608-6701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	08/02/2022

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Directions to “ VICTORIA LOPEZ LPC” Practice Location

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