MEDICARE: MELISA ROMERO-LOPEZ ACMHC

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	14023002-6009	UT

General Provider Information

NPI Number	:	1265242630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISA ROMERO-LOPEZ ACMHC

Provider Business Mailing Address
First Line	:	7070 S UNION PARK AVE STE 150
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-6043
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7070 S UNION PARK AVE STE 150
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-6043
Country	:	US
Telephone Number	:	385-321-1391
Fax Number	:

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

Provider Enumeration Date	:	01/08/2025
Last Update Date	:	08/05/2025

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