MEDICARE: MS. AMPARO LOPEZ LCPC

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	180.007086	IL

General Provider Information

NPI Number	:	1336385830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMPARO LOPEZ LCPC

Provider Business Mailing Address
First Line	:	2144 W HURON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1306
Country	:	US
Telephone Number	:	312-545-1563
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 N GREEN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-5996
Country	:	US
Telephone Number	:	312-545-1563
Fax Number	:

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

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	01/05/2009

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