Provider Demographics
NPI:1538477575
Name:LOPEZ-CEPERO, TANIA
Entity Type:Individual
Prefix:MS
First Name:TANIA
Middle Name:
Last Name:LOPEZ-CEPERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10210 N 32ND ST
Mailing Address - Street 2:BUILDING C SUITE 215
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3827
Mailing Address - Country:US
Mailing Address - Phone:602-478-7260
Mailing Address - Fax:
Practice Address - Street 1:10210 N 32ND ST
Practice Address - Street 2:BUILDING C SUITE 215
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3827
Practice Address - Country:US
Practice Address - Phone:602-478-7260
Practice Address - Fax:602-482-2155
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-15690101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional