Provider Demographics
NPI:1093826927
Name:LOPEZ, NORMA (PSYD, LCSW)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PSYD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91223
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78709-1223
Mailing Address - Country:US
Mailing Address - Phone:512-496-7884
Mailing Address - Fax:
Practice Address - Street 1:3407 W SLAUGHTER LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5714
Practice Address - Country:US
Practice Address - Phone:512-496-7884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31752103TC1900X
TX3-1752103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0030PBOtherBCBS
TX108173905Medicaid