Provider Demographics
NPI:1710766118
Name:LOPEZ, MARTHA LYDIA (LPC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:LYDIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 VISTA HERMOSA ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6524
Mailing Address - Country:US
Mailing Address - Phone:956-207-9242
Mailing Address - Fax:
Practice Address - Street 1:1002 VISTA HERMOSA ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6524
Practice Address - Country:US
Practice Address - Phone:956-207-9242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional