Provider Demographics
NPI:1174860696
Name:LOPEZ, OLUWASEYI ANNA (PA-C, LPC)
Entity Type:Individual
Prefix:MS
First Name:OLUWASEYI
Middle Name:ANNA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PA-C, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11673 JOLLYVILLE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4211
Mailing Address - Country:US
Mailing Address - Phone:512-579-0304
Mailing Address - Fax:
Practice Address - Street 1:11673 JOLLYVILLE RD STE 201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4211
Practice Address - Country:US
Practice Address - Phone:512-579-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88249101YP2500X
TXPA09152363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional