Provider Demographics
NPI:1619540648
Name:LOPEZ, ANGELICA RENEE-DURANT (RBT)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:RENEE-DURANT
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 W SPRING CREEK PKWY
Mailing Address - Street 2:STE 602/614
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024
Mailing Address - Country:US
Mailing Address - Phone:972-596-0035
Mailing Address - Fax:972-596-8080
Practice Address - Street 1:4105 W SPRING CREEK PKWY
Practice Address - Street 2:STE 602/614
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024
Practice Address - Country:US
Practice Address - Phone:972-596-0035
Practice Address - Fax:972-596-8080
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician