Provider Demographics
NPI:1821333758
Name:LOPEZ, MARIBEL B
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:B
Last Name:LOPEZ
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 1:1800 RIVER RD
Mailing Address - Street 2:APT 86
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-1263
Mailing Address - Country:US
Mailing Address - Phone:509-930-3548
Mailing Address - Fax:
Practice Address - Street 1:1800 RIVER RD
Practice Address - Street 2:APT 86
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-1263
Practice Address - Country:US
Practice Address - Phone:509-930-3548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor