Provider Demographics
NPI:1083372346
Name:LUZ MARINA LOPEZ COUNSELING AND CONSULTING SERVICES LLC
Entity Type:Organization
Organization Name:LUZ MARINA LOPEZ COUNSELING AND CONSULTING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:MARINA
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-205-6546
Mailing Address - Street 1:210 NE 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-6460
Mailing Address - Country:US
Mailing Address - Phone:954-257-1008
Mailing Address - Fax:
Practice Address - Street 1:138 NE 1ST ST # A-204
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6604
Practice Address - Country:US
Practice Address - Phone:954-205-6546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)