Provider Demographics
NPI:1073168266
Name:LOPEZ, TRESIE MENISE (CFC, CPC,CMC, PYSD)
Entity Type:Individual
Prefix:MRS
First Name:TRESIE
Middle Name:MENISE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:CFC, CPC,CMC, PYSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 NEW BYHALIA RD STE 3A
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3718
Mailing Address - Country:US
Mailing Address - Phone:901-690-9696
Mailing Address - Fax:901-328-5578
Practice Address - Street 1:366 NEW BYHALIA RD STE 3A
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3718
Practice Address - Country:US
Practice Address - Phone:901-690-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18107097101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1073168266Medicaid
TN1073168266Medicaid