MEDICARE: MR. ALFONSO L. LOPEZ JR. LPC, LMFT

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	106H00000X	Marriage & Family Therapist	5059	TX
2	101YM0800X	Mental Health Counselor	18408	TX

General Provider Information

NPI Number	:	1023216991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALFONSO L. LOPEZ JR. LPC, LMFT

Provider Business Mailing Address
First Line	:	1539 MCKINLEY AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78210-4346
Country	:	US
Telephone Number	:	210-533-5454
Fax Number	:

Provider Business Practice Location Address
First Line	:	1539 MCKINLEY AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78210-4346
Country	:	US
Telephone Number	:	210-219-3789
Fax Number	:

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

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	01/25/2024

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