Provider Demographics
NPI:1568220218
Name:LOPEZ, JULIETTE M (AMFT)
Entity Type:Individual
Prefix:
First Name:JULIETTE
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91031-0102
Mailing Address - Country:US
Mailing Address - Phone:626-567-0802
Mailing Address - Fax:
Practice Address - Street 1:10200 SEPULVEDA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-3316
Practice Address - Country:US
Practice Address - Phone:323-879-9176
Practice Address - Fax:818-484-4084
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142121106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist