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NPI Code Detail

MEDICARE: JAELEN LOPEZ

MEDICARE: JAELEN 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1750233920
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAELEN LOPEZ
Provider Business Mailing Address
First Line : 2250 E PROSPER TRL BLDG B
Second Line :
City : PROSPER
State : TX
Zip : 75078-2785
Country : US
Telephone Number : 972-312-8733
Fax Number :
Provider Business Practice Location Address
First Line : 2250 E PROSPER TRL BLDG B
Second Line :
City : PROSPER
State : TX
Zip : 75078-2785
Country : US
Telephone Number : 972-312-8733
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2026
Last Update Date : 02/11/2026

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Directions to “ JAELEN LOPEZ ” Practice Location

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