Provider Demographics
NPI:1124227798
Name:BATEMAN-LOPEZ, LILY (LPC)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:BATEMAN-LOPEZ
Suffix:
Gender:F
Credentials:LPC
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 263
Mailing Address - Street 2:
Mailing Address - City:TIERRA AMARILLA
Mailing Address - State:NM
Mailing Address - Zip Code:87575-0263
Mailing Address - Country:US
Mailing Address - Phone:505-588-7205
Mailing Address - Fax:
Practice Address - Street 1:US 84 CR 324 #14
Practice Address - Street 2:
Practice Address - City:TIERRA AMARILLA
Practice Address - State:NM
Practice Address - Zip Code:87575-0250
Practice Address - Country:US
Practice Address - Phone:505-588-9506
Practice Address - Fax:505-588-7188
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health