Provider Demographics
NPI:1497166706
Name:LOPEZ, KETY (LMHC)
Entity Type:Individual
Prefix:MS
First Name:KETY
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 N MIAMI AVE
Mailing Address - Street 2:APT W 908
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-3544
Mailing Address - Country:US
Mailing Address - Phone:786-366-6030
Mailing Address - Fax:
Practice Address - Street 1:80 SW 8TH ST
Practice Address - Street 2:SUITE 2185
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-3003
Practice Address - Country:US
Practice Address - Phone:305-915-5748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10097101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health