Provider Demographics
NPI:1144784190
Name:LOPEZ, MARIA ESTHER (MA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ESTHER
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10921 PELLICANO DR STE 110
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-4604
Mailing Address - Country:US
Mailing Address - Phone:915-313-4114
Mailing Address - Fax:
Practice Address - Street 1:10921 PELLICANO DR STE 110
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-4604
Practice Address - Country:US
Practice Address - Phone:915-313-4114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66021101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty