Provider Demographics
NPI:1033585088
Name:LOPEZ, ALEXIS CARMEN (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:CARMEN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 E LOS ANGELES AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2871
Mailing Address - Country:US
Mailing Address - Phone:805-582-4080
Mailing Address - Fax:805-579-6010
Practice Address - Street 1:1227 E LOS ANGELES AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2871
Practice Address - Country:US
Practice Address - Phone:805-582-4080
Practice Address - Fax:805-579-6010
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2020-12-23
Deactivation Date:2016-06-02
Deactivation Code:
Reactivation Date:2016-08-12
Provider Licenses
StateLicense IDTaxonomies
CA992981041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical