MEDICARE: LIZARELI BRAVO 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1053112979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIZARELI BRAVO LOPEZ LPC

Provider Business Mailing Address
First Line	:	5506 MOULTRIE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-7153
Country	:	US
Telephone Number	:	832-866-8331
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 BONAVENTURE WAY STE 156
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-8007
Country	:	US
Telephone Number	:	346-440-1800
Fax Number	:

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

Provider Enumeration Date	:	03/24/2025
Last Update Date	:	07/22/2025

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