MEDICARE: ANGEL LOPEZ LMHC, NCC, MCAP, QS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor	MH13694	FL

General Provider Information

NPI Number	:	1477989507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL LOPEZ LMHC, NCC, MCAP, QS

Provider Business Mailing Address
First Line	:	8249 SW 149TH CT APT 204
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-3103
Country	:	US
Telephone Number	:	786-319-7035
Fax Number	:

Provider Business Practice Location Address
First Line	:	14802 SW 183RD TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33187-1929
Country	:	US
Telephone Number	:	786-319-7035
Fax Number	:

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

Provider Enumeration Date	:	09/20/2013
Last Update Date	:	02/12/2024

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