Provider Demographics
NPI:1639364508
Name:LOPEZ, LAURA DENISE (MS LPC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:DENISE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS LPC
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 271606
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78427-1606
Mailing Address - Country:US
Mailing Address - Phone:361-728-8161
Mailing Address - Fax:
Practice Address - Street 1:2507 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-7013
Practice Address - Country:US
Practice Address - Phone:361-728-8161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58907101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional