Provider Demographics
NPI:1891179321
Name:LOPEZ, CRYSTAL VILLALOBOS (LMFT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:VILLALOBOS
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7520 SOMBRILLA AVE APT A
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4634
Mailing Address - Country:US
Mailing Address - Phone:805-431-4142
Mailing Address - Fax:
Practice Address - Street 1:4507 DEL RIO RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-1933
Practice Address - Country:US
Practice Address - Phone:805-462-4230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104718101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA96704364E34167OtherMEDI-CAL