MEDICARE: LAURA MELISSA QUEZADA LOPEZ

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	102121	TX

General Provider Information

NPI Number	:	1558206052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MELISSA QUEZADA LOPEZ

Provider Business Mailing Address
First Line	:	PO BOX 31678
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79931-0678
Country	:	US
Telephone Number	:	402-590-9794
Fax Number	:

Provider Business Practice Location Address
First Line	:	1635 N LEE TREVINO DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-5174
Country	:	US
Telephone Number	:	915-505-3606
Fax Number	:

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

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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