Provider Demographics
NPI:1417335878
Name:LOPEZ, MARY-KATHRYN (MS, MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MARY-KATHRYN
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS, MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 S PARSONS AVE STE H
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6042
Mailing Address - Country:US
Mailing Address - Phone:813-454-3769
Mailing Address - Fax:
Practice Address - Street 1:911 S PARSONS AVE STE H
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6042
Practice Address - Country:US
Practice Address - Phone:813-454-3769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3006106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist