Provider Demographics
NPI:1417494535
Name:LOPEZ, LUIS A (LPC)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N LEE TREVINO DR STE C4
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5164
Mailing Address - Country:US
Mailing Address - Phone:915-801-4270
Mailing Address - Fax:
Practice Address - Street 1:1600 N LEE TREVINO DR STE C4
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5164
Practice Address - Country:US
Practice Address - Phone:915-801-4270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health